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P(:RFIIT CHARGE none
OtJti� R� CONNECT I ON FEE
PAID BY
1YPt-. OF BUIEDING ._ ZVj� ' _ UATE CONN�.�CTE.D
SERVICE RATE � < INSPECTION FEE
CONTRACTOR plic BY DATE
SIZE OF CONNECTION ASSE55MENT PAIS
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BUILDING PERMIT APPLICATION 11 Y TIGARD MATE
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FJR THE WORK HEREIN INDIr,AT, D 13UILDERPHONE — —
�" OR AS SHOWN AND APPROVED IN THE ACCOMPANYING, PLANS AND SPECIFICATION:, OWNERPHONF
LOT NO. ^—----
OWN10i U3 O's JOB ADDRESS I J 910 541 I v i 4DO W HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER �— ADDRESS —� i.U17SIGNER _
STRUCTURE_ ❑NEW_ r REMODEL _ ❑ADDITION ❑REPAIRt-1 ❑RENEWAL ❑F19E DAMAGE —1 ❑DEMOLITION
0 RESIDENCE -['1COMM DEDUCATIONAL ❑GOV'r ❑RELIGIO''US OPATIO OCAR PORT ❑GARAGE (:1 STORAGE CJSLAB []FENCE
—0.801gU ❑MOVING ❑CONDITICNAL USE LJ DESIGN REVIEW ❑COUNCIL APPROVED -- SIGNS
0' HEATUSE ZONE_`_1 BLDU.TYPE,_ — FIRE ZONE PLAN CHECK BY I °_ _ HEAT
;-~~3.sujjq 6tSmo x183 "a�. Summerfield Ll nw.
I "une dwelling w/atteched t�ura 6s 2 'Jedrarim — :nth.
rmit., 4,1744 .. *C.e'sx.00 — —
40 20 1 14:o,; �
HEIGHZ_._-------NNQ__TQRIES
BUILDING DEPARTMENT SET BACKS FRONT j(3 " REAR LEFT SIDE �* RIGHT SIDE
Permit r
�- — THIS PERMIT 19 ISSUEC SUBJECT TO TME REGUI_AT!ONS CONTAINED IN THE BUILDING raE, ZONING
Plan Check { REGULATIONS AND ALL APPLICABLE CDDES AND ORDINANCES, AND IT IS HEREBY AG('CSD .a1AT THE
--- WORK WILL HE DONE IN ACCORDANCE 'AITH THE PLANS AND SPECIFICATIONS AND IN COMP:.iANCE WITH
SUb total1 j ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES N07 WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR ,NO SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State fax QCE�SE. SEPARATE rEP%TS. �OUIRED FOR SEWER, PLUMBING AND HEATING
Total ;1.Of%.00
By
APPLICANT OR AGENT
Approved Receipt No.
i _ _
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
o
Permit No./-5,
Flouoh-in
Fixture
Filial
HEATING
Contractor
Permit No.
797-
Gas tw Oil
Roug
h-in
Final
BEWERI
F Inal
DRIVEWAY
Final
Stom Drainage
(Rain Drain)Final
Smfe"llit
Cult i Street Final
e4)pr-ch
DEPT.FINAL TEMPORARY' CERTIFICATE C)CCUFANCY Final
cEwriricATE OCCUPAW-v
Laxiscilping
Zoning Final
AIA