12370-12372 SW WALNUT STREET 1-370-72 SW WALNUT STREET
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Ulty of Tigard
INSPECTION REQUEST
for
INSPECTION TIM-C.: PERM IJ NO. :
DATE: DATE ISSUED .--_�_--
OWNERS NAME : /"x 0"
ADDRESS:
CONTRACTOR :
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UNIFIED SEWERAGE AGENCY NO. ___ _ __5088
WASHINGTON COUNTY DATE __ 5-16-75 _
'TY 0F Ti ar
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!' PPLICATION FOR SEWER CONNECTION PERMIT
OWNER: - _ attiet3__---------_
OWNER'S -
STREET
Portland -- f3regun ---
`�_ CITY STATE ZIP
BUILDING SITE: LOT__3-____ BLOCK _ 2-- ---- ADDITION _--Cusl- Arx-as-__
TAX LOT N0. .__._.____.______.__.___ TYPE OF OCCUPANCY
1 M •S%1:7 "/ 1
ADDRESS _5AI&_-_W a_l n u_t-_ Street
DWELLING UNITS_ ._____ Y-2__ - __ ___ FIXTURE UNITS
SURCHARGE IF APPLICABt-E -_-5-0....to ,doe chamherlafn-anii_30-0 to - -lnr�t _.hw-fights
1050
PERMIT FEE _- ___ INSPECTION FEE 35____ TOTAL DEPOSITED -___.1085
(j_\ILM (EXISTING) BUILDING SEWER SYSI-FIJI
the Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPI-IC,ANTC
SEWER PEHMI V
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
i
LINE SIZE 411. __ INSTALLER
I� r,_CEIVED BY_ _� c�r"_
(AGENCY OR ITS AGENT!
COMMENTS: (3Qd�-c T,4/01(o
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE— ___,19 f� �° 0 287
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. I)WNER PHONE -- —_—_—___.
.larkls 1,'Oduetx•; 5*wQ ;
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor C)17 :4
Permit No. _MI-7 7e�At 7
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/ Rough-in
749.7r ' t��kJC. �" Fixture
Final
D,S h✓r� yt� HEATING
Contractor
Permit No. —
_ f. �"psra _ Gas or )if - — -- —'_
Rough-it,
/TT �,,� 1 , v .-,� F' AVS: /, �,v • Final — - ---
10 SEWE --71-
I Final _
DRIVEWAY' ---
Final
Storm r-ainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A ro:,ch
SLOG.DEPT.I"NAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
7 — y- Landscaping —
Zoning Final
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(1 t rr •� ��_____,_�. PERMIT N 0.
ADDRESS
PERMIT CHA Gt none
OWNER f0l�NNIION FEE
PAID BY
TYPE OF BUILDING DATE CONN CTED
S[RVICE RATE INSPECTION INSPECTION FEE
CONTRACTOR � �� :, : ,,__,� �� --��t .��a , �„
PAID BYDATE
SIZE OF CONNECTION ASSESSMENT PAID
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