12195 SW KING RICHARD DRIVE 12195 S.� King Richard Dr. KC
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KIM CITY CIVIC ASSOCIATIGN
AT'F' JRAT )N 1R Ai1GHI'TfiCAANAL AND STBWIWAL MANGES
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1. AWAUKr PKMM M;E S X ILL BE DODUJE D OF WE U.,QUF MM C1LM". IF TIiI:AE IS
AN OtaML. M, TFiE QB.IFCIZON 1✓,IIJ. BE RELAYED TO THE RESIMU ASKING FOR THE
QLANCE.
2. a'U*UT TRIS FM ALSO AOLJ(PMJYIEIG DMIING(S) TO THE K.C.C.A. ADMINIS'IIt IM.
3. r:V(Xt Mt!("IU 3AB. CJ.ANGES ARE SUET. ELT TO REVIEW BY Mi K.C.C.A. DCMCcI) OF
Dom.
4. A WUJ)IM PMffT WIST BE OBTALMD Ml THC CITY OF TIGARD Fit 41,. I!"(JVOOM
(106`T= MR $5W.00. OWLkCT ED WAIAEN - 639--4171.
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FLAN CHECK NO.
l or inspections ca- 6 39-4 L 75
PERMIT NO. /1�0 /
CITY OF TIGAPJ 639-4171 uATE --
BUILDING PE#tMII
P.O. Box 23397, Tigard OR 91223 TAX MAP _—LOT NO. SUBDIVISION
OWNER %�' T 6''> `�/�/ >� T JOB ADDRESS —c „:�� �L. �7 `moi c i�Nt'
GUILDER STATE r�"� STATE REG.HO. EXP.DATE
BUILDER PHONE
ARCHITECT—__ PHONE _---
STRUCTURE O NEW Cl REMODEL ❑ ADDITION ❑ REPAIR O MOVE ❑ OTHER 0 DEMOUT.UN
❑ RESIDENCE a COMM ] )EDUCATION ❑ IND ❑ RELIGIOUS. O-ACCESSORY O GARAGE (j OTHER O FENCE
OCCUPANCY �j_LAND USE ZONE BLDG.TYPE =j FIRE ZOt4 PLAN CHECK BY _ _4EAT
SEWER PERMIT I
CXx.LOAD FLOOR LOAD HEIGHT No .STORIES AREA /f'��' NO.BEDROOMS_ _ VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR L Er',SIDE RIGHT SIDE
Permit THISPERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICMBLE CODES AND OROINAW.ES,AND IT IS HEREBY AGREED THAT THE
Ptah Check WO)%K WILL BE 'LONE IN ACCORDANCE WITH THE PLANS ANO S?ECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLIGIBLE CODE) AND ORDINANCES.THE ISS'UAI:q.,1E OF THIS PERMIT DOES "OT WAIVE
lPf.(X F" RESTRICTIVE COVtVANTS.CONTRACTOR AND SUR COWTRACTORS TO HAVE CURRENT CITY BUSINESS
TAXPERMITS.SEPIA:TE PERMITS REOUIREO FOR S!:WER.PLUMBING AND FIEATING.
State Tax Ssrx,
SDC
TOUI APPLICANT OR AGENT
— P()G t
Prepd. _
Recelpl No
Bal.Due
— ---�--- laaikd 8y -.APProved By
OC _ RECEIPT b
- --__�— -- --- DATE PD.
I WER CONNECTION _S - AMOUNT PD.
[WER INSPECTION—S
EWER :1URCNARGE S �_