11834 SW PACIFIC HIGHWAY a--- I ---
11834 SW PACIFIC HIGHWAY
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CITY 0 75 N° 0375
BUILDING PERMIT APPLICATION TIGARD DATE r 19
THE UPIDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICA.'I ED OWNER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
Q_WNER Chuck Dunn ADDRESS 11834 'i.W. BUILDER PHONE
ENGINEER
x1111 DDR Geno Butler ARCHITECT _ DESIGNER--
;
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
--`�^�=—- - --- -- Contractor
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Permit No. —_.—�--
Rough in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough in _
Final
SEWER
Final _
DRIVEWAY
Final
Storm Drainage _ —
(Rain Drain) Final
Sidewalk
Curb&Street Final
_ Approach _
BLOG.DEPT. FINAL, TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
tc Ice'
Address 11634 S.w. Pacific Hwy. � Permit No. 470
Permit charge
Owner Texaco Station Connection fee' 637.70
Paid by
Type of building Service Station Date connected
Service rate 3•U0 per month Inspection fee 3 '
Contractor Paid by Date
Size of connection 4" Aeseesment Paid