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16790 SW Queen Mary _
King City
BUILDING DEPARTMENT, TIGARD NO. 0557
PLUMBING PERMIT
holder of a valid plumbing contractors license is hereby
authorized to cause piumb"nq work as herein noted to be installed in accordance with the plumbic; code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(A) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors &1d sub-contractors.
Address—.----.-- Date._—_.—
I -- NUMBER OF -TOTAL PERMIT NO.'S
TVPE OF PERMIT ITEMS FEE ON EACH AMOUNT (Office Use Only)
—
Single Family-1 beth-tech _ �. 25.0C___
Duplex-Each 1 beth unit 25_00
Additional bathrooms-each _ _ 10.00
Mobile Home Space-each —_ - _ 15.0.0
INDIVIDUAL FIXTURE FEES_ _ ___
Ito 50 Fixtures In 1 building-each , -______3.00
51 to 100 Fixtures in 1 building-each __-_- 7.50
101 to 200 Fixtures in 1 build) -each V 2.00 _
201 or more Fixtures in 1 building-each _ 1.50
MISCELLANEOUS
Bullding Sewer-1st 50 ft. -� 10.00
Sewer--each additional 100 ft. ___ 10.00
Water Service to building _�_ 5.00
Private Water Syst9ms-each 100 ft. 10.00 _
Other S if
PERMIT For Plumbing Inspersion Phone (139.4191
1% State Plumbing Contractor By
TOTAL RECEIPT NO.. Issued By
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_ 16790 SW Queen Mary
King City
BUILDING PERMIT APPLICATION KING CITY DATE lI?/1�1 ,,s -_ 1305
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE r =
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE _
LOT NO.
OWNER J, e,tilTOtt JOBADDRESS 167'10 Para 1�.►E^ntt,�
aIRemalaar„_Thm Alir .7-vi lino
('(1�1Crapt ENGINEER
BUILDER." :f'01•clahln " ivinr / ADDRESS 11r', r'L" R2nd Ayp,-.jtic'! DEStONER -+- --
STRUCTURE ❑ NEW ❑ REMODEL 'CI ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE Ll COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO Cl CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY -3 LAND USE ZONE "'-� -BLDG.TYPE r) • __FIREZONE_ ----PLAN CHECK BY _ HEAT
^loss evi -.tin4; reofe d pati(N fr,T- ',un Lloor^ (n V )")
'1C: hc�.tt.i�,rr or r�l'ti�i•illtr.
SEWER PERMIT#
OCC.LOAD FLOOR LOAD l . - HEIGH r _ NO.STORIES AREA l -i NO.BEDROOMS- VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE _
Permit THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONINC
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check I WORK WILL BE DONE IN ACCORDAN^.E WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I ICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
— - -- SD,,—
Total _ _ __
PDC# APPLICANT OR AOF.NT
By I.
Recelp,No. --------------- -----
Approved H ADDRESS PHONE