10375 SW JOHNSON STREET 103"15 SW JOHNSON STREET
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BUILDING PERMIT APPLICATION TIGARD GATE / �_ � 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT F:,A THU WORK HEREIN LNDICATED `.Js•t �� ����L ��'�'U\
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANE AND SPEbFICATIC .s. O NERrHI��
OWNER ` s- ' ADDR'.SS "I BUI;DE_H
ENGI4EER
IlUILDEq r-� ARC'i1TECT _ DESIGNER
STRUCTURE ❑NEM 1t_--tt iEMODEL DADVITION 'NLPAIR _RENEWAL ❑FIr�R--(�T -AMAGE ❑DEMOLITION
RESIDENCE ❑COMM 0EDUCATIONAL ❑GOV'1 _❑RELIGIOUS❑°ATIL EICAR PORT ❑GARAGE [I STORAGE OSLAB ❑FENCE
—0E10ND ❑MOVING ❑CONDITIONAL USE L.IDESIGN REVIE.V —DCOUNCIL APPROVED ❑SIGNS
OCCUPANCi _LAND USE ZONE BLDG.TYPE_ FIRE ZOVE_— PLAN CHECK BY_ HEAT—
QCs LOAD ___ _FLOOR LOAD__- _ HEIGHT _� -_— NO.STORIES _ i AREA VALUE
U
BU+LD(NG DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIUHT SIDE
-- J THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check r REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREB', AGREED THAT THE
-- -- WORK IVILL BE DONE IN ACCORDANCE WITH THE PLAN, AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1°o State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total /
By
APPLICANT OR AGUNI
Approved Receipt No.
ADORrSS
DATE INSP, TYPE INSPECTION REMARKS �^ PL.UIVIBIN1i GATE
--�j---_ _—
Permit No.
Rough-in
_— Fixture
Final
HEATING
Permit No.
Gas or Oil
r,ou h-in --
_- Final
---� _—_ `—_------ - SEWER --
—_------- Fine! _
DRIVEWAY
Final
--� -- -,--.--- __ Storm Drainage
(Rain Dra n) Final
-- -- — _-_ Sidewalk
--- --�— _ __ --_ Curb&Strut Final
_—_ _ _ Approach _
BLOC.DEPT,FINAL TEMPORARY CERTIFICATE Ot:CUPANCY —�
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
s
i
i
1
7
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UNIFIED SEWERAGE AGENCY No. --- 5005 _
WASHINGTON COUNTY
CITY OF
I
APPLICATION FOR SEWF_ R CONNECTION PERMIT
I
OWNER: ---_.-------- - -�--._.---- -
OWNER'S ADDRESS: _—___`___._---------_-_--- -.____— -----
STREET
STATE ZIP
CITY
BUILDING SITE: LOT-__. ._- BLOCK -_____________ ADDITION _
TAX LOT NO. -_---_._- IYPE OF OCCUPANCY -___-_-----_.___ _------._---
ADDRESS --- I Z.I.3_ :. - S. (0, rv_
DWELLING UNITS------...-- - ----�-- _-------- ..._ FIXTURE UNITS
SA4-R ,4�&E IF APPLICABLE ___.. -57 ° - —
�� tti .^s
PERMIT FEE _J�'��-'- ------- INSPECTION FEE ?5.---- TOTAL DEPOSITED ��3�-� • `'o
(NEW)
(LEXISTINC) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT.___---
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE .. _-----_ _ - INSTALLER
RECEIVED BY___ __.--
(AGENCY OR ITS AGENT)
COMMENTS: _._------__.._--------. --.--------.._-. _ _.---_—_-----_ __ _- —_-
PERMIT TO CONNECT
Tigard Sanitary District F
PERMIT N9 780 DATE
PERMIT IS GIVEN TO
OF "% r: .L c
TO CONNECT A
TO TILE SYSTEM OF TIGARD RAN'TART DISTRICT
AT / r
.. 10, e, 3 :� " V.,r ..o-
THIS
o.TRIS PERMIT MUST BE POSTED ON THE DESCRIBED AWMISES UNTIL CON-
NEC"fION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $......dl,, ; ...............TIG{ARD SANITARY DISTRICT
BY
CONNEC"I'ION INSPECTED AND APPLI)VED
- Sup ndent
Address. _ /0,3 ,,S -S(U PsMit N . /f U _
Ir .>
ea
Name of Occupant Permit cYAUVO ° >
-----___--- Connection fes_ _oW N
------- _.._ -------- Paid by.
Date connected,'
Type of Building �f3iDE�iC�` Inspection f"_ �� r
Service Rate �_,2°`, Paid by -T�eDN/i�J Date
Contractor J rc1h401 A) — Assessment Paid
Size of connection <�