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�l!ILDING PERMIT APPLICATION TIGARD DOTE N4 %� I
THE LINDEISIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. owNERPHONE__— —
UWrrER � //lr�•" 31 ADDRESS __ BUILDER PHONE
ENGINEE'p
91111.L2 1y S ('v e- /f /4- _- AI.:HISIErT —__ ----- DESIGNER
STRUCTURE ONEW DREMODEL ADDITION ❑REPAIR [:]RENEWAL- [:]FIRE DAMAGE ❑DEMOI_ITIOIy i
0RESIDENCE ,COMM [:]CDU'-ATIONAL' DGOV'T ❑RELIGIOUSDPATIO ❑CARPORT ❑GARAGE ❑STORAGELDSLAP ❑FENCE t
_ DBOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW El COUNCIL APPROVED [:]SIGNS �-
/� ..
OCCUPAi1C�_-LAND USE ZONE-: � BLDG.TYPE_ � FIRE ZONE ;L. PLAN CHECK BY HEAT
OCC, LOAD _,—FLOOR LOAD HEIGHT — NO.STORIES AREA VALUE y U�•?
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT S;DE RIGHT SIDE
Permit r,
THIS PERMIT IS ISSUF7 SUBJECT TO THE REGUI.ATIONS CONTAINED IN THE BUIL DING CODE, ZONING
Plan Chick RE%3ULDTIONS ANG ALL APPLICABLE C%-,,ES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- - -''- WORK WILL BE DONE IN ACCORDANCE W'IH THE ' ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH 4
Recordi-.ig ALL APPLI^ABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PCRMIT DOES NOT WAIVE
-- --- —"— RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I%State LICENSE. SEPARATE PERMITS REQUIRED FOq SEWER, PLUMBING AND HEATING.
Total 9
BY _ APPLICANT OH AGENT Ole
Approved 1 Receipt No.
--J ADDRESS PHONE
AU
�I
VATE INSP. TYPE iNSPECTION _ REMARKS PLUMBING TI DATE
I�lp4"40 Contractor Yal
y ��1. 7N/ivies G�-r9LL _ l�ir'i�a�Yc:r__ Permit No.
/ z-a �•'. Ft01.1h-in
-
~� Fixture
-2-7_"er - ----- Final ---
HEATING
_----
_ Contractor
�' "fir' T�-M'1 f'JL'@�1 f1►rnra T��t'1 __ _1SSLiId Y�./T�7f, Permit No. - — —
uQ i�_.CSa7►�S bKt�.df'ta3T�t2 was or Oil _
Rough-in
Final
SEWER
Fina;
_-- — _ DRIVEWAY - _—
Final
Stogy n Drainage
(Rain Drain) Final
Sidewalk
t7n
StrA�t Final
ch_ _
BLDG.DEPT, FINAL TEMPORARY CERTIFICATE OCCUPANCYCERTIFICATE OCCUPANCY apiig
Filial
CITY OF TIGARD
12420 S. W. Main Strut
TIGARD, OREGON 97123
APPLICATION FOR BUILDING PERMIT
t New construction ❑ Demolish ❑ Addition Remodel ❑ Move j
ZONING DATE IS,'j'QED � o"rJS� BUILDING PERMIT
DATE RECEIVEDHUILDIFG FEE $ �L ;`r, No.
1, / >' y 9
PLAN CHECK $ a— - -
BY �I OTHER $ c�� VALUATION $
TOTAL % S7-7r $� f L RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISII 'D WITH APPLICATION
LOT # MAP # _ CENSUS TRACT - J JOB #_
Architect or Engineer
Address ` Phone
Owner _ — L',• L,_ A-z",
Address` rA• __—_---- _ Phone -
Bui.lder r L- -- --------
Address- i'e" r/ ------ ------- ___Phone---.---_ ^
BUILDING USE Single Res. [] Multi Res. l_J Comm. ❑ Industrialj]
OCCUPANCY GROUP L-) %1u. of Storips _ Total Heightj Area of Lot_
Type of Construction I II ?,11 IV V Floor Area B 12 -
Set Backs: Front _ Back L.Side R.Side`
Private Sewer Pipe Size _ Sewer___ Septic Tank ❑
water Service Pipe Size_---- Storm Gower ❑ Ditch ❑ Drywall❑
Street and Curb Requirements
Driveway Width` _ - _No. of Parking Spaces_____
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
/j, e Arima
ADDRESS ASSIGNED. 11T/ / ..5, «�_- I�r r --—
FIELD CHECK BY�_-- -----------------_— __--- `DATE-1/_�!1_z�%
PERMIT APPROVED
It is understood that all work will conform with applicable codes and ordinances
of the State of OLegon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occupancy has been ssuad by the City of
Tigard Building Inspector. -��-
s�a'gnature of A, lican�
PERMIT `r0 CONNECT
Tigard, Sanitary District
PERMIT N? 1197 DATE - ---- -- ---- —
PER511T 1S GIVEN TO
OF
TO CONNECT A
TC TILE F,YSTEM OF TIGARD SANITARY DISTRICT
AT
THV; PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NWrION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FRE FAID $ ...................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Date — -- ----Superintendent __---
WdresszLm�f Permit No.
Permit charge Z
Connection fee Zj)�'_
Paid by
..ype of Building Date connected
service Rate +_ Inspection fee
:ontractor Paid by Date
;ize of connection �� Assessment Paid