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15895 SW QUEEN VICTORIA PLACE
KING CITY
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BUILDING PERMIT APPLICATION KIS►'G CITY DATE_ __, 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMII FOR THE WORK HEREIN INDICATE[5 BUIL-1ERPHONr,
OR AS SHOWN AND APPROVED IN 'THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE—_�
LOT NG ——
OWNER L;, _!— JOB ADDRESS _^w • LYl1"0] d�f. HOME ADDRESS _ __—
�' ARCHITECT
ENGINEER
BUILDER a� k""i�' S ` '.r'. _ ADDRESS _ DESIGNER_ �—
STRUCTURE ❑NEW ❑P.f MnDEI- ❑AnOITION REPAIR ❑RENEWAL ❑FIRE DAMAGE_—❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB CFENCE
❑BOND _ ❑MOV ING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS scaoz
OCCUPANCY LAND USE ZONE BLDG.TYPE —FIR=ZONE` PLAN CHECK By_______ HEAT, .
aw xvxx:T dw l tv L 111 240# (AMP"UM ehingi2so bow ,YVI A&I PIK' CMUuOt Iii
FLOO l_q.BQ. �SEL�tHL_--.____N-Q� zI481F.,�e.____9BEB_.___.
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit > .,,:�'
—' THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAIN_J IN THE BUILDING CODE. ZONING
P'an Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
---"— WORK WILL BE DONE IN ACCnRDANLF WITH 1. PLANS ANDSPECIF17ATIONS AND IN COMPLIANCE WIIH
Sub-total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CON'TRACIORS TO HAVE CURRENT CI rY BUSINESS
State Tax LICENSE. SEPARATE PERMITS RFrIUIRED FOR SEWER, PLUMBING AND HEATING.
'Total „till --
By
_ O9 17_ -A VPLICANT OR AGENT
Receipt No. � ' /
DATE INSP. TYPE INSPECTION !— REMARKS PLUMBING DATE
Contractor
Permit No,
Rough•in
--_ Fixture
Final ^.
HEATING
Contractor
Permit tio.
-- ----' Gas or Oil
Rough-in
Final
SEWER
i Final — —
DRIVEWAY —
Final —
Storm Drainage 4
(Rain Drain) Final _ V
Sidewalk --1
Curb&:trevt Final
Approach
BLDG. DEPT.FINI.L TEMPORARY CERT'FICATE OCCUPANCY —
CERTIFICATE OCCUPANCY Fina
Landscaping
Zoning Final
Kind City CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE `��""° ' iso` N° U:)G
THE UNDERSIGNED HEREBY APPI-IES FOR APERMIT rk)R THE WORK HEREIN INDICATED
Or AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS ANC SPECIFICATIONS. OWNER PHONE
11rEIBIBtt�rl 15895 Queen Victoria P1. 664-1169QV�NEH _ _ ADDRESS BUILDER PHONE _
ENGINEER_
��Eq Kon ParkerARQHITECT i)9Q1 SSE• -�.SUSAYAve. DESIGNER 4
STRUCTURE ❑_NEW _ ❑REMODEL MADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
Q RESIDENcr- ❑ ;OMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB [:]PENCE
❑BOND ❑MOVING ❑CONDITIONAL USE El DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
Q�gCUPANCY_—.LAND USE ZONE-- BLDG.TYPE FIRE ZONE— PLAN CHECK BY-_.---_— HEAT
Construct Brick fireplace
OCC.LOAD FLOOR LOAD__ HEIGHT �_- NO,STORIES AREA VALUE 1,Sao
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit —=_- — ---- -- ---------------------THIS PFRMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINFD IN THE BUILDING CODE, ZOIJING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED 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%Stite 7, LICENSE. SEPARATE PERMITS REOUIRED nnR SEWER, PLUMBING AND HEATING.
Total
By
--{ Ap ANT OR AGENT
Approvr.d EJ { Receipt No. '
ADDRESS i- PNON
f
-----------
DATE INSP TYPE Iy PECTION REMARKS PLUMING -r DATE
'1 ' ontr ctor
Permit No.
Rough-in
-- _� Fixture
- ------- -
Final
— -- —
HEATING
Contractor _
Permit No.
-- — -- --- Gas or Oil
—_ 17ou hg in _—
Final
SEWER
Final
DRIVEWAY1/ --- —
__ - -- /, — --�- Final
7r v
Storm Damage _
^_ — L(Flain Drain) Final
Sidewalk
VJ— Curb&Street Final
- ---
Approach ---- — -
SLOG DEPT. FINAL — TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final