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ELMMULMELAILM
CITY OFTIFAPFLAKUT
RD I.-AIL-AMIT NO. : BUF1909,13.15
COMMUNITY DEVELOPMENT DEPARTMENT
13*,15S"' Hall Blvd_P.O nom 23397.Tigard,Oregon 97223,(503)639-4175 DAT'F: I!ii 51,3EI Ael 26/89
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This permit is issued subject to the regulations contained in Title 14 nEX,ETl:`I W.) 3,5-93
of the TIVIC. State of Oregon Specialty Codes. zoning regulations ..............
and all other applicable codes and ordinances, and it is hereby PIPAJUIPF-11' JWWECTIONS
agreed that the work will be done in accordance with the p;ans and F WAM 1.NG
specifications and in compliance with all applicable codes and F-11:N61
ordinances The issuance of this permit does riot waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void It work is not started within 180 days,or if work is suspended or
abandoned for a period el 180 days any time after work has
commenced It shall be the responsibility of the permittee to assurr,
all required inspections Pre requested and approved
Ku.pKittee
Issued Rv V Al I I I if 4 1 IT.,I-T-711 I I I If I 7777=77 T
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DES(,RIBED ABOVIF
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CITY OF' H: iNZ CITY
15300 S.W. 116th AVFNUE
KING CITY , OREC-0:4 Q7224
( 503) 639-4082
APPLICATION FOR
COMPLIANCE REVIEW BOARD PERMIT
1 . NAME OF APPI ICANT : 1710h if S. vDCiL-�J _
ADDRESS: -2 2X5- J'
TELEPHONE NO.� ,-'.31._ �—
ADDRESS OF PROPOSED IMPROVEMENT SiS'irlf" �9✓' /i'r9c�d.�
� . TYPE OF CHANGE ,, IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT
IS REQUESTED. (DESCRIBE BRIEFLY/ATTACH TWO COPIES OF PLANS
OR DRAWINGS OF WHAT IS PROP)SED) :
2- ale-re
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3 . NAME AND ADDRESSES OF CONTRACTOR: ,
4 . NAMES AND ADORESSE:S OF' NEIGHBORS W140 MAY BE AFFECTED 6Y THIS
CHANGE , IMPROVEMENT OR CONSTRUCTION. ( IT IS THE APPLICANT "_
RESPO"N�SIBILITY TO NOTIFY EACH NEIGHBOR) : _
_ /vn d•Jaa/ e//i c t en �Ce.JJo rn_ a�_6ei1 —�m� I pT
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SIGNATURE OF APPLICANTTy�L� o/
t DA I F (1F APPLICATION C/i` � ZO --
APPLICATION RECEIVED BY DATE_�s1- S9 _
APPLICABLE FEE RECEIVED $1 .oD UTHER/,570(2 TOTAL FAID,�,ri .00__
APPLICATION REVIEW SCHEDULED: DAIS___ _
COMPLIANCE REVIEW BOARD - DECISIFIN: Gtti.el i i_,n/ezr�
Y A P P R O V E Q, ,�� .cs,•= DATE_ V-a,c-J`-7__i
D'EN IED__�._ DA 1 E — _--- --
CONDI T IONS:
Til/87
O niormation/ lnstructlons on reverse )