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BUILDING PERMIT APPLICATION TIGAR0 o�►rF__-___- y/`�
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER
L�PHONE
OR AS SHQ�►N AND APPROVED IN THE ACCOf1,PANYING PLANS AND SPECIFICATIONS. LOT Nq,G�� �a
�J�OBAOC�)RESS /� ��Z L ARCHIrECr I
ENGINEER
@UIIDER
i-�il ) �; AGGRESS
STRUCTURE (g f/EW ❑ REMODEL ❑ ADDITION _ 0 REPAIR ❑ RE_NEWAL 0 FIRE DAMAGE DE��OL�
GOV'T ❑ RELIGIOUS ❑ PAe10-
❑ CA_R?OAT ❑ GARAGE G STORAGE ❑ SL
AB❑ _11
to NCE JCOMMA ❑ GDU(ATIONAI ❑ HEAT 3RES SLOG.TYPE FIREZONE -PLAN CHECK BY
OCCU?ANCY LANOUSEZONE
-----------
SEWER
PFJiMIT/ - __-
OC.�:.LOAD FLOOR LOAD HEIGHT
NO.STORIES AREA NU.BEDROOMS VAJ-UE
-- — REAR LF_FT SIUE RIGI(T SLOE
BUILDING DEPARTMENT__ SETBACKS FRONT
F
w THIS PERMtr IS ISSUED SUOJECT TO THE REGULATIONS CONTAINED IT ITMHERE AGREED TV-Al
REGULATIONS AND ALL APPLICABLE ODES AND ORDINANCES.
SUANCE
� �� WORK WILL OE DONE IN ACCORDANCE WITH TIIE PUNS AND SPED FTHIS0E AND O C NOT V
AND
S. THE
DES
t'SjitlCTIVeCOVENAN�CONTRAACTORIA D SUB CONTRACTORS TO 1 AVE CU RR TENT CITY OU
r'- LICENSE SEPARATE PERIAITS REQUIRED FOR SEWER PLUTAgIUG AND HEATING.
SIStU Tu - - SnC— t
TOW OR AGENT
POCJ
Br Reollpt No.
SOL
PUC -- -----
SEWER CONNECTION-- —.
SEWER INSPECTION 8
SEWER SURCHARGE S —
Comments:
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2. 2
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BUILDING RECEIPT /
NAME: %/ DATE:
ACCT. N DESCRIPTION AMOUNT
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10-432 Building Permit Fees $
10-431-600 Plumbing Permit Fees $
10-431-601 Me,hanical Permit Fees $
10--230--501 State Building Tax $
10--433 Plans Check Fee
30--443 Sewer G?nnection (201x)
30-202 Sewer Connection (80X)
30-444 Sewer Inspection
51-448 Street System Dew. Charge (SDC) $
52--449-610 Parks I System Dew. Char3e (PDC) $
52-449-620 Parks II System Dew. Charge (PDC)
31-450 Storm Drainage System Dew. Chrg (SSDC)
10-230•-505 TRFD (95%)
10-478 TRFD (5%) s
10-230-506 Washington County Fire N1 (95X) _
10--x178 Washington County Fire M1 (5%) S
10-220 Amart/Wedgewood =
(bs/1214P)
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Building Permit No.
Location
Date ---
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Certification of Registration
With the Builders Board
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I � � •i,doing business as (dba) ,
,,h am registered under the provisions
of ORS Chapter 0 Oregon tianebuilders Law) .
My Builders Board Registration Number is
My regi;*ration is in full force and effect and expires on _
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