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BUI1 DING PERMIT APPLICATION Cor. TIGARD DATE
THE UNDERSIGNED HER r BY APPLIES FOR APE RM IT FOR THE WORK HEREIN INDICATED BUILDER PHONE----
OR AS SHOWN AND API'mOVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE__
LOT NO.---.
':)WNER-J 411,1 JOB ADDRESS 3 Hf)I,0,L ADDRESS
ARCHITF-C"
ENGINEER
BUILDF-i') ADDRESS DESIGNER
STRUCTURE ONEW xxQP.i.-mnDEI. DADDITION CIREPAIR LIAENEWAL [:]FIRE DAMAGE []DFMOLITiON
O'LRESIDENCE CICOMM CILDUCATIONAL OGOV'T (:]RELIGIOUS OPATIO OCAR -�_,FIT []GARAGE C]STORAGE[]SI A13 [:]IENCE
DBOND [:]P.IOVING LO.. CONDITIONAL USE ODESIGN REVIEW DCOUNCIL APPROVED
OCCUtA AND USE ZONE BLDG.TYPE --FIRE ZONE, PLAN CHECK BY_ HEAT__
quost's qjg-utiun to ex-sung dw,-Jjnr,/
F_lQQB_LQAP, H IQHT NOM
__U,A,OAQ NO,BEUROCIMS
—BUIL DING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
51.0[] THIS PERMIT IS ISSUED SWD_!FCT TO THE REGULATIONS CONTAINED IN THE BUILDING COVE ZONING
Plan CheckREGULATIONS AND ALI APPLICABLE CODES AND ORDINANCES, AIN U IT IS HEREBY AGREED THAT THF
28,00 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WIT'S
Sub-total *16, ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOSS NOT WAIVE
RESTRII:TIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURREN'i CITY BUSINESS
State Tax 2,0L LICENSE SEPARATL PERMITS REQUIRED FOR QrWER, PLUMBING AND HEATING.
Total
By APPLICANT OR -AC—IFNT------,-----
Approved _q.t w Re(i-ijil N,i
DATE TYPE INSPECTION REMARKS PLUMBING DATE
—L717� -------_.-_.`—_- Contractnr
Permit No.
r,
-31-74f �^ .�! r GC D - Fixture --- --------
' ----- Final I—
.�tZ- - 1i,,.- — ---- HEATING — - -
__�
- - — ---- 'Contnctur
Permit No.
Gas or Oil
.�— -- Roug' n -- --
Finrl
SEWER
-- --- Find
DRIVEWAY
Final
Stoft Drainage
(Rein Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINAL -'rtmPORARY— CERTIFIC- a:I�CCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final