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12040 SW NORTH DAKOTA STREET 12040 SW NORTH UAK)TA STREET n Y C, Z O d O N .-1 wn..naw v.+�r.M... .NM+r'�M.Mw�r..,,.,q..w+..s.�,�,�y,....,...o,r,-y�..r�....n•�..., g, ,.} NFn14VP"PA'.tw+•'Y"+'�+wM^w^"�"'M"'. ..r:w pw..., , CITY OF BUILDING PERMIT APPLICATION TIGARD DATE 0105 THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED "1 '• # OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE QWNER Robert Larsel1. ADDRESS 12040 9.1w, N:, Osk0t1- BUILDERPHONE _ ENGINEER BUILDER �i ARCHITECT DESIGNER _ STRUCTURE _❑NEW ❑REIIODLL 7 0AODIr10N El REPAIR !❑RENEWAL _OFIRE DAMAGE ❑DEMOLITION ©RESIDENUE Q,-,OMM ❑EDUCA(IONAI UGOV'T ❑RELIGIOUS❑PATIO OCARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE ❑BOND DMOVING ❑CONDITIONAL USE ❑DESIGN 'F"VIEW' OCOUNCIL APPROVED ❑SIGNS OCCUPANCY--LAND USE ZONE_, _ BLDG. TYPE __FIRE ZONE� PLAN CHECK BY._ _� HEAT4 .d OCC, LOAD _FLOOR LOAD i HEIGHT T NO.STORIES AREA VALUE s BUILCING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE Pet-nit — ---- --- — —_-- THIS PERMIT IS ISSUED SUBJECT 1'O THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGRECD THAT THE WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS 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%State LICENSE. SEPARATF PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING Total By " '— ------ APPLICANT OR AGENT —'�-"'�—'-- Approved Receipt No, ' ADDRISS ---- No —- - --- DATE INSP, TYPE INSPECTION REMARKS Y PLUMBING DATE OKContractor Permit No. Rough-in Fixture Final _ HEATING Contractor Permit No. Gas or Oil Rough-in _ Final SEWER _ Final DRIVEWAY Final Storm Drainage_ (Rain Drain) Final Sidewalk Curb a Street Final A roach BLDG.DEPT,FINAL_ TEMPORARY T CERTIFICATE OCCUPANCY Final CERTIFICATt:OCCUPANCY Landscaping Zoning Final 1 PERMIT TO CONNECT Tigard Sanitary District ERIviTT N� 9 DATIi � - c►iry " PERMIT IS GIVEN TO OF _ r TO CONNECT A q + TO THE SYSTEM OF TIGARD SANITARY DISTRICT AT THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON- NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM- PLETED, PERMIT FEE PAID $....._........................_...UIGARD !SANITARY DISTRICT By CONNECTION INSFFCTED AND APPROVED Address�%?0�}�,�GtD Ko f.11 --_ Permit No. Name of Occupant __ Permit charge --- ------- - -- --- - Connection fee- 9 J?7 - Paid by ----- _----_ -_ -___ Date connected 7-1 i - eo Z Type of Building_ - --------.- -__ Ii spection fee Service RatE _ _-_ Paid by -_-_Date _- Contractor _ Assessment-_-_ _- - Paid- -_- A Size of connection.�I ___