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IN'PECT101. NOTICE
City of Tigard Building Department
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639-4171
TYI)q of Inspection
Date Requested
Time A.M. P.M.
Address
Permit
Owner Lot
Builder
The following Building Code deficiencies are reqvired to be corrected:
Xna 10
4C
Pmented to mApproved
Inspolnur Disapproved
Dote
CALL FOR REINSPECTION
YES
NO
BUILDING PERMIT APPLICATION TIG,�RD DATElu _ 19-0. 113313—
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER FHuNE ��s Layf
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
11`` O p Q LOT NO. 000
OVJf4ERIAK JOB ADDRESS D0� 3� bta00� �. 7
r n /� �_�, AflCPftT�'f
BUILDER �-� %v �' ADDRESSx 22f C.%eybI�ESI Keh 9irkent4ias- -
STRUCTURE 0 NEW ❑ REMODEL ADDITION ❑ nEPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE U COMS,I ❑ EDUCATIONAL L-1 GOVT ❑ RELIGIOUS PATIO G CAR?ORT C] GARAGE ❑ STORAGE CI SLAB❑O FENCE
U-.GiiPANCY t.AND USE ZONE- BLDG.TYPE �_FIRE ZONE PLAN CHECK BY HEAT; -.
LFAY oQ IJI�' Ro tun¢ v>'►-t - Go �QP
eA
SEWER PEN,1 TO �� ! 9z &AA
OCC.LOAD C-LOOR LOAD U HEIGHT /6 NO.STORIES AREA �}O NO.BGD':OOMS VALUi�mft
Bf'_DING DEPAkTMENT __ SET BACKS FRC`N REAR '^ LEFT SIOE R;GHT SIDE
Permit ;I±tS PERMIT IS ISSUED SUBJECT TO THE REGUL'kTIONS CONTAINED IN THE BUILDING GODS,ZOWN3
REGU!.ATIOPIS AND ALL APPLICABLE CODES ANU ORDINANC:=S, AND IT IS HEREBY AGREED I-PAT THE
Plan Check /91_$17 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COIAPLIA14CE
WITH ALL. ArPLICABLE CODES AICD ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
,Sv�tota.l 1060. ' RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1 .�� LICENSE SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
m
;StaTax L1
Total $ SDC— � a �� e� Gr... ( 0 r� L41
PDC# APPLICANT OR AGENT -�-��
By
Rec431pt No.
Approved - -' ADDRESS PHONE.
SDC (� J �q � n
_PUC 64: Rd Y 4'vt f2ec:-- . {f'
SEWER CONNECTION S t� 4 r
o
SEWER INSPECTION S
SEWER SURCHARGE S — _ _