13775 SW 72ND AVENUE-1 13775 SW 72ND AVENUE
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City y of Tigard }
Ni�F*� "7,_('T ION REQUEST
for
4NSPECTION TIME: PERMIT
DATE: _L__ DATE I S S U
OWNERS NAME :. �' � _ .�-Er«r-7
ADDRESS: ----- -- �a-�•-� _. _.__�
CONTRACTOR ..-
'*EST : Air 0, Water[] , Visual p , Lot)
�4ESULT: Approved Disapproved C rc ;ing p
SKETCH.
INSA '1..PDATE
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CITY OF TIGARD
12420 S. W. Main Street
TIGARD, OREGON 97223
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish Addition ❑ Remodel u Move ❑
ZONING ___ DATE ISSUED_-7-7 BUILDING PERMIT
BUILDING FEE $ "—� No. i
DATE RECEIVED
By - PLAN CHECK $
---�- / ALUATION $
-- -`- - O''HER �tq(��� ECEIPT No, /p/,37
TOTAL $_ _7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N_Soo MAP $ a5j_' pe CENSUS TRACT _ _ JOB $_
Architect or Engineer_
Address _ Phone
/Zner �A.N . E1��h,�_�9��� --
'Addreas_� _:��ITHIS __ _—Phone (0bi-3id�l
Builder —___ �----
-I(ddress Phone-
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY�1;RDUP No. of Stories Total Height_ -_ Area of Lot-
Type of Construction II III IV V Floor Area B-
Set Backs: Front_ Back L.Side__ _ R.Side_ _ _
Private Seaver Pipe Size Sewer Septic Tank ❑
Water Service Pipe Size _ Storm Sewer Uitch ❑ nrywell❑
Street and Curb Requirements
Driveway Width ____— No. of Parking Spaces _
S-PARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADRESS ASSIGNED��3� --
FIELD CHECK IIY_ _- DATE
PERMIT APPROVED BYP1,,J2"t�„
It is understood that all work will conform with applicable codes and o nances
of the State of Oregon and the City of Tigard,10regon, and that the building will
not be occupied until a Certificate of Occupa y has been issued by the City of
Tigard Building Inspector.
5 gnat�ure of Appl cant+ ____-�