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City of Tigard
I ! F'ECTION REQUEST
for
INSPECTION "TIME : PERMIT NO. '
j DATE: — DATE ISSUE
OWNERS NAME ' _ u_.L.�� �it/c L_ � ,•�
ADDRESS :
I CONTRACTOR :___ ---_—
y TEST . A r D , Wat arm] , Visuc;1 0 , La'• ,ratarj [l
RESULT: Approve Disapproved Disapproved 1 Pond-ng ❑—_�
I SKETCH:
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IN' SPEC TOR DATE
CNr1TF Attach supplementoI test data h e r e I
1
CITY OF TIGARD
12420 S. W. Main Sfrwf
TIGARD, OREGON 9M23
APPLICATION FOR BUILDING PERMIT
New Constroction ❑ Demolish ❑ Addition. � Remodel ❑ Move❑
ZONING_ DATE ISSUED _ BUILDING PERMTT
DATE RECEIVED BUILDING FEE $'JAJ,d C _ No.
BY PT tN CHECK $ iBG U-AL1
OTHER J.% $ VALUATION $ /13131
TOTAL $ RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT # /7 MAP # CENSUS TRACT JOB #
Architect o.r Engineer
Address
^ � �Q x01 _ i ^^ Phone _
Owner --
Address I
/�lSSo _�_t✓ Sdt ix,,..✓ —Phone
Builder Gi
Address--P-L ;1 _-&L /9/ Aur�rw »_ 9 00" _Phone 0'7f,/�Zz
BUILDING USE Single Res. � Multi Res. Comm. Industrial❑1 U
OCCUPANCY GROUP No. of Storiei Total Height Area of Lot
Type of Construction t II III IV V Floor Area B 1 2
Set Backs: Front Back _ L.Side R.Side
Private Sewer Pipe Size Sewer_ —Septic Tank ❑
Water Service Pipe Size Storm Sewer ❑ Ditch ❑ Drywell❑
Street and Curb Requirements
Driveway Width_ _No. o` Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFOjR�MATI7►ON
�.�--
ADDRESS ASSIGNED ,aim YDS S"t:2tf4
T
FIELD CHECK BY DATE
PERMIT APPROVED BY
It is understood that all work will conform with applicarle codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, an,l tLat the building will
-lot be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector.
i;ignatare of Applicant