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BUILDING PERMIT APPLICATION TIGARD DATE_ October 26 --.ie �s 4542 i{
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE Z32-7106
ORAS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER- .ir. 6 'irs. Alke:, _ JO_B_ADD_R_ESS 11640 aw )IsL
ARCHITECT
ENGINEER
BUILDER Lorenty lruu:n Go. ADLRESS DESIGNER__
STRUCTURE ❑ NEW ❑ REMODEL ❑ ADDITION 4REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
EIXRESIUENCE 11 COMM ❑ EDUCATIONAL ❑ GOWT ❑ RELIGIOUS ❑ PATIO CJ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY .-A=I—LAND USE ZONE _ "7 BLDG.TYPE 50—FIRE ZONE PLAN CHECK BY _ !�TwHEAT._—_.
:repair fire damia�e at Residence. _Includes roof structure reglaceumr.t.
All per UBG Code•rsguireweto.-s.
SEWER PERMIT M -
OCC.LOAD FLOOR LOAD HEIGHT Zo NC.STORIES I AREA NO.BEDROOMS VALUE j2,_000.
BUILDING 17,_^ARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit — _ 92.50 -_�THIS PERMIT' IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
REGULATI'JNS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 40.00_ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL 4PPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 17Z•SU _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tex 3.11)
--- —
Total 136.20 SDC
PDC# APPLJCAI,T On A EE T�
By l:H
1 Recelpt No.
Approved l fll ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DACE
/�' Contractor ~'
L_l�,- - Permit No.
i
"ougi-in - --
u`� fixture
—A Final
HEATING
•! — Contractor
- Permit No.
Gas or Oil
-- - - - —- Rough-in
--- — ---- ----- ----- -- Fine!
SEWER — I
Final
DRIVEWAY --
-•----------- Final
—.? —�
Storm OraineVe
(Rain Drain)Final
Sidewalk
Curb&Street Final _
— - Appronch
PLoo. DEPT.FINAL TEMPORARY CERTIFICATE nCCUPANCY Finai -
CERTIFICATE OCCUPANCY [Lantscaping
7unin9 Final
BUILDING PERMIT APPLICATION TIGAa:) DATE_ __ � t9
THE LINDERSIGNEL,HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED [WILDER PHONelJZ
OR AS SHOWN AND APPROVED IN THE,,CCOtAPANYING//PLANS JAND SPECIFICATIONS. OWNER PHONE .
/`% JOB ADDRESS _ �j( x —LUT -
0.1 rJ ER ------
ALNGIN(EGi
� ENGINEER
BUILDER / GAIL ADDRESS _ _ DESIGNER
STRUCTURE ❑ NE ❑ REMODEL Cl ADDITIO_N_– EPAIR _ Cl RFNEWAL ❑ FIRE DAMAGE L] DEMOLITION
P-IRESIDENCE Cl COMM ClEDUCATIONAL 1:1GOV'T C RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE G STORAGE C3 SlA80 FEW;E
oc-.UPANCY LAND USE 7.ONE �� BLQG TYPE FIRE ZONF �' _PLAN CHECK BY HEAT__
�)tWER
OCC.LOAD FLOOR L04D HEIGHT NO.STORIE 1 AREA rte" NO.BEDROOMS VA.L' 'e
BUILDING DEPARTMENT — SETBACKS FRONT -- REAR LEFT SIDE - RIGHT SIDE----
P,rmIt _ . J� T141S PERMIT IS ISSUED SUBJECT TO TOE REGULATIONS CONTAINED IN THE I•.UILDING CODE. ZOWN"
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREOY AGREED TY.A.T 7H
(Plan Check V I d WORK WILL HE DONE IN ACCORDANCE 'NITH THE PLANS AND SPECIFICATIONS AND IN COTAPLIANC!
�f VITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERPAIT DOES NOT WAIV:
5v rtelal d O RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITT HUSINES�
C— --- UCEitSE_ �FPARATE PEMMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
Stata Tax yU
SDC.—
TotalI
PDCN APPLICANT OFi AGENT
By
_ Receipt No.
PpADDRESS — ------ -- - ior�r ------
roved
SOC -
PDC
SEWER CONNECTION S __
SEWER INSPECTION 5
SEWER SURCHARGE S
i
Address Permit No. f v
Name of Oc^upant Permit charge
J��►ti�.e. ,r
LQ
f
Paid by
Date connected
Type of Building_ Inspection fee
Service Rate_ V ✓ Paid by __Date
Contrr !or Assessment----Paid----.----
Size
ssessment --Paid___ __.__—_Size of connection-
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