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City of Tigard
INSPECTION
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BUILDING PERMIT APPLICATION to Y TIGARD OATE 19 7. �-�' w - ��
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THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
BUILDER PFIONr _�_Ll_!f_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE -
1 LOT NO.-- --
OWNERr ramsi{ eriif *311.AD0RESS4((i) SW Ltun,&ta i�u4d HOMEADDRESS -
ARCHITECT
ENGINEER
BUILDER u;. ADDRESS _-DESIGNER
STRUCTURE -= EINEW _�❑RFMn7EL ❑ADDITION C3 REPAIR ❑RENEWAL [-]FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T []RELIGIOUS[:]PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED LISIGNS
OCCUPANCY LAND USE ZONE_.r BLDG._TYPE FIRE ZONE— PLAN CHECGC BY CTed HEAT _
I:amo4it . in of exiatinu single fsm,ily nsls !npca pwr 11,UsC. Coda & Ti -
--- ity Llrlinan4as• Styptic Tank to ug pumpoo and filled uAh send ur cSuy ut•
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- Colundatiun galls to UG radarsd mar c-_qd s
QgC LOAU_ - ELQQR__.LOAD..—_._----HE GISL— BEDROOMS VALUE _-__
BUILDING DEPARTMENT SET BACKS FRONT _ REAR_ LEFT SIDE ____ RIGHT SIDE
Permit
—�-' THIS PERMIT IS ISSUED SURJFCT T'O THE REGULATIOPi i CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- — WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE:WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax r, 40LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND ��EATING.
Iotal .14(1
By APPLICANT OR AGENT � —
Approved Receipt No.
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DATE INSP. TYPE INSPECTION RKMARKB PLUMJBINO DATE
Contractor
Permit No,
Rough-In
Fixture
final
NEA rlNG
I
Contractor —�
Permlt No.
Gat or Oil
_ Rough-in
Final —
SEWER --u
Final
—_ DRIVEWAY
final
Storni Drainage
'gain Drain) Final —
_ Sidewalk.
Curb&Street Final
Approach
BLDG. DEPT. FINAL. TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Fine!