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CITY OF TIGARD
12M G W. aISM am*
TIGARD, ORA1900 el=
APPLICATION FOR BUILDING PERMIT
UW Construction
De►aolish Addition LJ Remodel � Mc'vv ;.,�J
DATE ISSUEU-Icy—__ BUILDING PER112T
Z C01 VG_L._j_a No.
DATE RECEIVED BUILDING FEE
PLAN CHECK Sr� VALUAATTIION$5oo.on --
HX-_-- OTHER $ v .05 state
RZCEIPT Nn.�„L
TOTALSa 5.05
M SETS OF PLANS AND PLOT PLANS MUST BE FUPNISHUD WITI4 APPLICATION
LUT 1 _--.—-
MAP 1 251 10 CENSUS TRACT JOB
_-----
Architect or Fnqineer �.---- -.__-_----.---____--------
rhone _
Address
r.ner Farmers Insurance Group
---------- .__
AdJr�ss
4686 Wilshire Blvd. , Los Angeles, Cs. Phone----
..�._ __ _�-
Puilder Tom Bronson - Frams tn Insurance Group,-___..____- -- -- ------"
Phone
Address S.W. Verne, L'.% l OrcQon _ 97223n(
BUILDING USE Single Res. [D Multi Res. l _1 Came. F-1 Industri.al�__)
OCCUpWY GROUP, No. of Stgriss__-- Total Heigh t._.___ Area of Lot-J,
V Floor Area B 1 2--
Type of Construction Z II III IV --
Hack L.side R.Side
Set Back p: Front •----------�
Private Sewer Pipe Sewer Slse_ —__ Septic Tanj j
Water Service Pipe 92se Storm Sewer a Ditch El Drywall []
Street. and Curb RequireIments --. -•--
Driveway Width` --_„ ___
No. of Parking Specee_
SEPARATF PERtftTS REQUIRED FOR 9E►RER AND PLUM9ING
9PECI&L INFORMATION
dsaolish kenfel �� ---- --- — -
AL►DFIESS ASSIGNED____6045-5.Y._..1Wlu•----- - — --'
FIELD CHECF HY� --•-----------..._--.__. __
DATE --_---._..-
PERMIT APPROVED BY t�►1aa,�14le.t
i
understptxf than. all work will conform with applicable odes and ordin
flats of Oregon and the City of Tigard, Oregr�n, and that the building
ia�d until a Certificate of Oce Pancy has been iesnec► :,y the rite
l-mmudinq Inspector.
10" 0 p sant w T�.