16225 SW 93RD AVENUE 16225 SW 93RD AVENUE
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BUILDING PERMIT APPLICATION TIGARD DATE —f���/ __,19 92
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
1( LOT NO.
OWNER ,i. LaL.':y 6ray sunJ0_BADDRESS
_ _sL) 93TU
ARCHITECT
ENGINEER
BU16ER rray,.on Cunstr.CU- ADDRESS b'A(k_ SW barber Blvd. _DESIGNER Grayson Cu. ^_
STRUCTURE ❑ NEW ® REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE 1] COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY __:LAND USE ZONE R-7 ._RLDG.TYPE . N FIRE ZONE _w PLAN CHECK SY __~____HEAT__ '""
Pamodel oxisting singles family duelling. Add bathroom, repair fire
damage all per plans and coda. SEE CORRECTION SHEET ATTACHED.
Add 1 bathroom.
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 40 HEIGHT_ -- NO.STORIES 2 AREA 7 7 NO.BEDROOMS 4 VALUE CJnu.
SET BACKS FRONT 20 REAR tl LEFT
BUILDING DEPARTMENT900 HIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED DEIN THE BUILDING CODE, '
RIGHT SIDE
Permit ��� . ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 46.00 WORK WILL BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 136.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CIJRRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tex 4" 3.68
- SDC— �
Total $141.08 :=!_
-- PDCN APPLICANT OR AGENT
By — — -- r , . 1'
)�ecelpt No. ADDRE' S
Approved dpi r f— , 1=7 j�, c'NONF
i
s,DATE INSP. TYPE INSPECTION REMARKS ---- PLUMBING DATE
Contractor
Permit No. -
3-/
Rough-in 1
Fixture
oca Final
e4y;L HEATING -
�`" .- Contractor r�
Permit No.
-_ Cas or Oil
Roughen
A
Final
- - SEWER
Final --
DRIVEWAY
-� �— Final —
Storm Drainage
(Rain Drain)Final
Sidttvml k
Curb&Street Final
Approach
BLDG. DEPT.FINAL T TEMPORARYIFICAT�ANCY Final
CERTIr'ICATE OCCUPANCY
Landscaping
Zoning Final
I
y�
- SEINER PERMIT -o � _
Uf
Unified Sewerage Agency
of Washington County C I T Y OF DATE
OWNER. j �2A4 s;oni PHONE _ - 1
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
Sq'F SEWER ❑ LINE TAP AND SIDE aEWER ❑ LINE TAP
TYPE'•Vf+�C-CUPANCY.
,NEW ❑ EXISTING `-' SINGLE FAMILY ❑ COMMERCIAL
�EXIST. (PRIOR TO 7- 1 -70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS i
ADDRESS OF STRUCTURE :
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
Men calling for Inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at
the measurement given, the installer shall prospect three feet In all directions from the distance and depth given.
If not so located, the Installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will install a lateral at the location specified by "ie Installer.
FEES:
PERMIT FEE $ .� S
CONNECTION CHARGE
I. INE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL
APPLICANT - DATE
SEWER PERMIT
• N° 23332
ADDRESS OF STRUCTURE A4;
TAX MAF' TAX LOT SYSTEM - ;;A- �
LOT BLOCK OF n .1„:r-"ra.j
APPROVED BY DATE -+ ISSUED BY DATE
D. U. ' S REMARKS
oek �, T