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CITY OF _ 4
BUILDING PERMIT APPLICATION TIGARD DATE— 0 U 0 7
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED 635-5904
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
. 7' ' ; 1 r 620-1234
QWNER _ ADCRESS -- —_ — BUILI)EP,PHONE _
ENGINEER
JJU1LDE8 _ —__ AR HIT CT _- DESIGNER
-
STRUCTURE
�L ❑NEW _❑REMCDEL ❑ADDITION _ ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
LJ PESIDENCE_❑COMM ❑EDUCATIO'IAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE [:]STORAGE❑SLAB [:]FENCE
—OBOND —❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW _ ❑COUNCIL APPROVED ❑'. IGNS__��_
O,:CU"ANCY_—_!..ANJ USE ZONE_ -------BLDG. TYPE-_--FIRE ZONE__. PLAN CHECK BY__ HEAT __
QC.r,LOAD _ FLCOR LOAD HEIGHT NO,STORIES AREA _ VALUE —
BUILDING DEPA'ITMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Lit 361.00
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULAIIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
WORK WILL BE DONE IN ACCORDANCE. WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
ALL APPLICABLE CODES AND ORDINANCES. 1HE ISSUANCE OF THM PERMIT DOES NOT WAIVE
------- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINFSS
1%State I LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
---- ------
Approved Receipt No.
ADDRCSS PHONE
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
�7 -- _ - Contractor
}a,.u4 � Permit No.
G 7 Y (2Ir- /-?d -- — Rou h-in —
Fixture
Final
HEATING
_ Contractor _
— - — Permit No.
Gas or 06
Rough-in.--------
Final
ou h-inFinal —`
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final _
Sidewalk
A Curb&Street Final
Approach
BLDG.DEPT, FINAL TEMPORARY CE RIIFICAIE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
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PERMIT.' TO CONNECT 40
Tigard Sanitary District
PERMIT N! 1429 DATE
5
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PERMIT IS GIVEN TO
OF
TO CONNECT .4
TO THE STSTEM OF TIGARD SANITART DISTRICT
AT
�:H16 PERMIT MUST BE POSTED ON THE ESC TBED PREMISES UNTIL CON-
(ECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
.PERMIT FEE PAID $.........�..7 ...............TIGARD SANITARY DISTRICT
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- - -------------------- --
CONNECIION INSPECTED AND APPROVED
Date Superlti—Mn�ent �/
r1 .t
1
Address_ 13200 S.4. Village Glenn Permit No. 1429
Permit charge,_
Owner _ Connection fee_ 375.00
Paid by Award Homes
Type of building RPs. Date connected
Service rate Inspection fea_—__ Z5 .00
Contractor Award Homes Paid by same Date
Size of connection 4" _ Assessment——Paid
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