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CIT � .-
BUILDING PERMIT APPLICATION ofY TIG � DATE 151—'7' -• 19----
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE, u��� 13
OR AS SKOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS,
OWNER PHONE
LOT NO.._.--
OWNER
dd .l "� ii3l'U JOB ADDRESSrI' )r1 ",' I `l1G'2 HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER Jim_ _ Gsrd! ADDRESS CIRENEWAL
STRUCTURE ❑NEW REMODEL _ ❑ADDITION [:]REPAIRLJRENEWAL ❑FIRE DAMAGE ❑DEMOL.ITION
QRESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV"r ❑RELIGIOUS❑PATIO ❑CARPORT QGARAGE ❑STORAGE❑SLAB ❑FENCE
_❑BOND (:]MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED _ ❑SIGNS
OCCUPANCY—`, 1LAND USE ZONE__BLDG.TYPE ✓ FIRE ZONE PLAN CHECK 13y___--- HEA A.
tW.Is parn;A iii for tII, prU4'ose) Uf
additional budroome and adding an att+achcad yaraye all Lgr + s,tkita;_blug, coura-'.'
1'11 Uccuperic:y cif' body-sums without_ r'in,al alporuval of b1dij. dopt. ras, plkly.
- - — 5 O C10.
QC".LOAD FLOOR I,.OAb FIEIQI�I.__—_ IYQ LS2Fil �' _ABLA.. .. _ .�Q,�Ir-Q.L94MS_�,CALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR — ; EI T SIDE -_� RIGHT SIDE —
Permit '.';r .l:t
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Check �`` L!(j REGULATIONS AND ALL APPLICABLE CODES AND C.IRDINANCFS, AND IT IS HERI=BY AGREED THAT THF
— -- WORK WILL BE DONE IN ACCORDANCE WITH 1 eff PLANS AND SPECIFICATIONS AND IN COMPLIANCE WI IH
Subtotal ALL •,,PPLICABLE CODES AND ORDINANCt:S. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTPICTIVF. COVENANTS. CONTRACTOR AND SUB CONTRAU'IORS TO HAVE CURRENT CITY BUSINESS
State Tax !. I.'. LICENSE. SEPARATe. PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total �V•
By -
APPLICANIOR AGENT
Approved Receipt No.
�.f----
A DT*f::55 ------ _'_ppo - -- -
OAJE INSP. TYPE INSPECTION / ,�- REMARKS PLUMBING DATE
v23-97 .1D ttV-�+ �E_' Contractor --
-� .If Permit No.
Rough in
q Fixture _
Final _
HEATING
Contractor
Permit No.
Gas or Oil
Rou h•in
_ Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
Sidewalk
Cin b&Street Final
A roach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
r? 1
f! 13
i
Address Permit No. /.2 0
Permit charge 1 `-
Owner — _ Connection fee
Paid by I
Type of Building fC4.-.Q Date connected
Service Rate Inspection fee / t,
c
Contractor^ Paid byDater 2 '
Size of connect4on -1 Assessment Paid
PERMIT TO u0NNECT
Tigard Sanitary District
'PERMIT N9 1? C0
DATE
PERMIT r,
_ IS (�IVBN TO `---
OF ... .J / ac4i
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITART DISTRICT
AT
THIS PERMIT MUST BE POS
ON THE DESCRIBED PREMISES UNTIL CON-
NECTION 18 MADE AND INSPE TION OF CONNECTION 'BIAS BEEN COM-
PLETED.
PERMIT FEE PAID ;... : ..,.a.....................TIGARDSANITARTDISTRICT
/
r? S
CONNECTION INSPECTED AND APPROVED