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CITY OF TIGARD
12420 S. W. Main Street
TIGARD, OREGON 97227
APPLICATION F( 7 .9UILDING PERMIT
New Construction Demolish Addition Remodel El Movef_1
CONING -- _1 _ DATE ISSUED .S`�Z-�_ BUILDING PliRMIT
DATE RECEIVED BUILDING FEE $ S.Ofl—� No.
ca
BY PLAN CHECK $
—'�— OT.NER $ d 5' /�; S�ilft"VALUATT N $ DO —
TOTAL $ RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHID WITH APPLICATION
LOT N-- _ MAP NCENSUS TRACT Y—_ -- JOB N
Architect or EngineerS//L1,M /C141 KA a/,'1
Address ,'/j 9C S!✓ /3"/QL14L !/1i ---------Phone _e r9f
Owner-- �;H /A/YA /CN/'cAt✓A
Address /49C` S�y� ����CLj/FIGNTS _ -_ Phoned-�.�(-�
Builder!--_ A 4 M E
Address _ _ Phone_
BUILDING USE Single Res. ---Multi Res. a Comm industrial
OCCUPANCY GROUP_-- No. of S --- Total Ifeigh A;:ea of Lot
Type of Consti,,:ction I I IV V Floor a B_�— 1` 2
Set Backs: Front__ _IB�c�a _ L.Sid v R.Side
Private Sewer Pipe i l 1' I S94fr _ Septic Tank U
Water Service P ize -_ Storm Sewer LJ Ditch Drywell❑
Street and Curb irem s
Driveway Width _ ---------No. of Parking Spaces —
SEe'ARATE PFRMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED �—
FIELD CHECK BY DATE
PERMIT APPROVE. '
It is understood that all work will conform with applica a codes and ordinances
of. the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of occupancy has been issued by the City of
Tigard Building Inspector.
SS—ignatu of Applicant
ME
Address ZL9 ri(d Q�,t�k,[��,a r� Permit No. 9101
Name of Occupant_ Permit charge
Connection fee
_ Paid by _
Date connected �J!LS tm 7
Type of Building_____. Inspection fee
Service Rate Paid by
C intractor Assessment Paid
Size of connection
i
PERMIT TO CONNECT
Tiga--d Sanitary District
PERMfT Nn 941 DATE I
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST' BE POSTED ON TPt7 DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION IIAS BEEN COM-
PLETED.
PERMIT FEE PAID �.. . ... ......................TIGARD SANITARY DISTRICT
B
---------- - - - ------- --- - -
- 27
CONNECTION INSPECTED AND APPROVED
10 MID
Date Superintendent