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ciTr OF N� 0340
BUILDING PERMIT iPPLICATION TIGARD DATE 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPCOVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNER L.d hinnamen _ ADDRESS 1163ti 5sUe Grslww, BUILDER PHONE
Schollhom a ENGINEER
BUILDER ARCHIJE T DESIGNER
STRUCTURE ❑NEW (-�❑REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL [:]FIRE DAMAGE _ ❑DEMOLITION
El RESIDENCE ❑COMM OEDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPOF ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
_❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APP,,OVED ❑SIGNS
OCCUPANCY_�LAND USE ZONE__ }I� r BLDG.TYPE- ) FIRE ZONE— PLAN CHECK BY rr>M -
HEAT__.-.________^.
-- — ostruct 1i .IIiditiun w4 1 , ,�r dUellinq for
------ - – bedroom M- mocso7 oq to upprovod p mns
OCC. LOAD _ FLOOR LOAD_ HEIGHT NO.STORIES AREA VALUE —
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE _
Permit -20,0r,
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS 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
Recording ALL APPLICABI " CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CON7PACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State •21 LICENSE. SEPARATE PERMI7S REOL:IRED FOR SEWER, PLUMBING AND HEATING
Total :?a 20
By r f• -
-_-- _ APPI.ic! NT OR AGENT
Approved Receipt No.
ADDRESS
DATE INSP.I TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
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/ri-?tom-/� _ cC�•,�!._ C'1�, ,.�� Permit No.
Rough-in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough•in ^_
Final
- ------ - --- SEWER
Final
----—------- --- ---
DRIVEWAY
Final
_ Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY ---
Landscaping
Zoning Final
�7
Addrem Z/J2�'� LG_�"-A rus�g� Permit No.,____
dame of Occupant_e,,, Permit ci,arge._�__
NGL E.4."44
__ --- - — — --- — o
----- ------- — Paid. by--------
Date connected
Type of Buildinq �_e�(� rr.� _ Inspection fee
Service Rate �- L' - Paid by Date _
Contractor" Assessment-lQ_t7•1. (,o O Paw
Size of connection
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