12595 SW PACIFIC HIGHWAY 12595 SW PACIFIC HIGHWAY
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CITY OF TIGARD
17420 %. W MNO WOO
,,ARD, ORlGON M"
APPLOATION FOR BUILDING PERMIT
New Construction C7 Demolish ® Addition ❑ Remodel ❑ Move❑
ZONING__LW_r__3_ _ DATE: ISSUED_,11 _kk-]3 — BUILDING, PERMIT
DAZr RECEIVED HUILDING FEE $ No.
BY PLAN CHECK S
' OTHER S VALUATION $ 5(10
TOTAL $_ �cj RECEIPT Nn.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1 MAP 0 CENSUS TRACT JOB 1
Architect or F.nyineer,
I Address
owner _----- - _.r—
Address _11995 S.W. Graanburg Rd. Phone_
Bui lder
Address s- ____ _ _ _ � ___Phone
BUILDING USE Single Pen, ❑ Multi Res. ❑ ` Comm. ❑ Industrial❑
OCCUPANCY GROUP _ No. of Stories-- -- Tot-1 Height_ ,_ Area of Lot-
Type of Construction I II III IV V Flcor Area B------ 1_-__ 2------.
Set Backs: Front----- Back_ L.Si(ie __ R.Side_
Private Sewer Pipe Siie Sewer_ ^_ Septic Tank
water service Pipe Sire-�--�_ Storm Sewer ❑ Ditch ❑ Urywell ❑
Street and Curb Requirements_______!
Driveway Wiclth_ - -_ No. of Parking Spaces
1 SEPARATE PERMITS REQUIRED FOP SEWER AND PLUMBING
4
SPECIAL INFORMATION
ADDRESS ASSIGNED 9R a__u. loaaitic Hug
MELD CHECK
PERMIT APPROVED BY � ►„_ [f.i L,J{,I�
It is understood that all work will conform with applicablecodes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building wilA
not be occupiee until a Certificate of..1017upancy has been iRsued by the City of
Tigard Building Inspector. r _
^9na —o f Appl icafit/
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I
Addrese-1 .`L'i �_� �J ►.;`..J__�_ Permit No. _..
Permit charge ----
DWner C innec t i cin fee
--.�..._._. Paid by
Type of building, Date connected
Service rate Inspection fee
Contractor Paid by date
Size of connection_ Assessment_ paid
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Address �•`1 l�aG!/�iLrt'`� Permit No.
Name of Occupant � 1 /Permit charge_._
ow, L` r Y9,C4 off-
Cauaec+M fee
_ Paid by..-
Date
y..Date connected
Type of Building -1A k i Inspection fee
Service Rate Paid by _- __-_ Date________
Contractor•_ _._ ___ Assessment----------- Paid
Size of connection