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CM' OF TIGARD
11420 5. W, Mrin Street
i1GARD, OREGO(1 97127
APPLICATION FOR BUILDING PE MIT
Nnw Construction ❑ Demolish ❑ Addition Remodel ❑ Move❑
ZONING - 0. 3 DATE ISSUED G_ 7- ;114 BUILDING PERMIT
DATE, RECEIVED BUILDING FEE $ u'-, No. ;Pit
BY PLAN CHECK $ -4rp-
OTHER $ y s VALUATION $ 7 n
TOTAL $ RECEIPT No.
Tho SETS OF PLANS AND PLOT PLANS MUST 9E FURNISHED WITH APPLICATION
LOT # MAP # CENSUS TRACT JOB #
Architect or Engineer
Address_— Y__, Phone
Owner_____
Address_�f33o0 eSw� ' e, �w "Ti G��_ Phone
Builder`
Address
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GF.OUP__X No. of 'Stories Total Height Aroa of Lot
Type of Construction I II III IV V Floor Area B`_-- 133G 2—__--
Set Backs: Frontd Bacck_4s` L.Si.de 2S"— R.Side___/O'
Private Sewer Pipe Si .e � (�__ Se Septic Tank ❑
Water Service Pipe _ Storm Sewer ❑ Ditch ❑ Drywe11❑
4
Street an"-`r1l Kcqui r nts
Driveway �dth No. of Parking Spaces ____
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS A5SIGNED ( jrp SOC 4• AC C 14ww-
FIELD CHECK BY _ _ .� __ _-_--� ,DATE /2•
Fol r?L,356i- 4u-<r#4j
PERMIT APPROVED BY I -
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of occupancy has been issued by the City of
Tigard Building Inspector. r ,
S gnature of Applicant