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October -:3a b5 5668
BUILDING PERMIT APPLICATION TIGARD DATE _— is
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNFR PHONE -_
aIvin Wr_
3mdra,Jr. 8065 SW gond 17
OWNER JOB ADDRESS _ _ ,J__ _
- -� ARCHITECT
ENGINEER
BUILDER "ame ADDRESS 025 25 SW Murdock, Tigard DESIGNER
STRUCTURE N NEW ❑ REMODEL L ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
D RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T 0 RELIGIOUS ❑ PATIO D CARPORT ❑ GARAJE ❑ STORAGE D SLAB❑ FENCE
HEAT_
�,� - 1'Th'
�x-BLDG.TYPE _SN—FIRE ZONE---PLAN CHECK BY
OCCUPANCY LAND USE ZONE _
j'nc��arr�c-t sia�l@..1..t�L�s!>til inr �� a •s t.®c__i u�rno� _ -------
SEWER PERMITk $kg'11(Il�uI ---_ xrnga ryeeA 4,}u __-4-bath
---
OCC.LOAD FLOOR LOAD 4k HEIGHT ZO- NO.STORIES 2 AREA 11122 NO.BEDROOMS t _VALUE
BUILDING DEPARTMENT SETBACKS FRONT REAR / LEFT SIDE _� —_ RIGHT SIDE
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Permit THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BU LUING CODE, ZONING
NU.OVA* REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS FIE RE
EE
THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN OMPLIANCE
/5li.UU WITh ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF 1HIS PERMIT DOES NOT WAIVE
Sub•tot+l _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
��• LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
State tax 64 vzJl •U�- *N,L.., .a,UU,reCejpt iMii156,YU•.lS--t3S
ITotO"'1.:,u� 204'.64 50.00 /' II? / / � ,�. �L-
-- PUCK 11150.00 APPLICANT OR A EN ..
By -
___-_ IIGI<, Receipt No. / ADDRESS - --PHONE
Approved- '_ _
I
DATE INSP.i TY INSPECTION --REMARKS _— PLUMBING DATE I
r't1 °�twatyr -,10-
ParrnitNo. 4 {
( -' h-4am _ y.37�_ 37
PEI Rough-in
Fixture
Final
HEATING
/— y'�� ----- Contractor
„ t _ _ Permit No.
Gas or 011
Rough-in
Final
SEWER -- --- I
Final - _-Y-
DRIVEWAY
-- _ -- -- —_ Final --
-- ---- ---- --- -----._ -- --- Storm Dreinnpe
(Rain Drain)Final _— 4
r
Sidewalk
Curb d Street Final
Approach
tILD6. DEPT. RIIIAL TEMPORARY — CERTIFICATE OCCUPANCY Flrul
CER'I'IPICATE OCCUPANCY _al
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