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CITY OP �,.�T
RI1ILQI�IG PERMIT APPLICATION TIGARD DATE r{;"y 7 , 19._ t N OSIS
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
lIR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
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OWNER --__-----ADDRESS fsly_ BUILDER PHONE
ENGINEER e-/Iblrk_ Ce'l `�' Y
UILDEB 0wrtat,
rr--�� ARCHITECT –_ DESIGNER
SSIRUCTURE L.JNE',J 0 REMODEL _– LJADDITION – _REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑UEMOi_ITION
Q RESIDENCE ❑COMM ❑EDUCATIONAL [JGOV'T IJREUGIOUSE]PATIO ❑CA14 POnT ❑GARAGE 0 STORAGE DSLAB ❑FENCE
QBOND ❑MOVING QCONDI rIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED OSIGNS
O.trCUPf,NCY_..._rLAND USE ZONE __BLDG.TYPE FIRE ZONE-__PLAN :HECK BY- _ HEAT____
rabj%ts gviuntj tmiii;i p�_ 4 and ai>
----- - t s 114'.3.17 t� 1 A o X j,,w L.i i l rj -----^----- �_
OCC. LOAD—_-FLOOR LOAD _HEIGHT – _-- NO.STORIES AREA – _- , VALUE �-
BUILDING DEPART"ENISET BACKS FRONI REAR LEFT SIDE RIGHT SIDE
Permit _ — -----.— _-----—_` -�
`—` IHIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALI. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
kecording ALL APPL,IC-BLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTCRS TO HAVE CURRENT CITY HUSINFSS
I%SI.,te —
7, RESTRICTIVE
LICENSE. SEPARATE PLRMITS REQUIRED FOR SEWFR, PLUMBING AND HEATING.
Total ! 74. —
By rt ;5
_-- of PI 1( ANI ()n Af:vNt
Approved Receipt No
txm
/ DATE INSP. TYPE INSPECTION ,REMARKS PLUMBING DATE
Permit No. `
Rou hc��in _- -
Fixture
Final
HEATING
Contractor
---- _--w Permit No. 4"13 _t,, 7-
Gas
-Gas or Oil
-------- - -------_ _...-- _ Final
SEINER
-- --- — Final
DRIVEWAY
-- - Final
-� -- -- Storm Drainage
---- --- --. .- ----- -__ (Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
ZoningZoning Final
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