11605 SW 95TH AVENUE-1 -- 11605 ,SW 95TH AVENUE
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I CITY OF 12 .9 7, u
BUILDING PERVIT APPLICATION TIGARD DATE ,9 �I- 0 5 9 3
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE _
NER Larry GIAW ADDRESS 1160 5*Wl BUILDER PHONE
Roger Smith ENGINEER
BUi DERARCHITECT ! DESIGNER
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STRUCTURE ❑NEW C REMODEI. ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ R,:SIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY--LAND USE ZONE R-78LOG.TYPE_ FIRE ZONE____ PLAN CHECK RY_ Y>�� HEA`
csrper�, i �jr U; .,:druufn La11 foundation whor® rlaeded
OCC. LOAD _^FLOOR LOAD HEIGHT _ --^ NO.STORIES AREA
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIC--:
F•drmit 16.00 — —_— ----•— __. �
THIS PERMIT IS ISSUED SURJECT TO THF RFOULATIONS i'.ONTAINFD IN THE BUILCING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY ,AGREED THAI' THE
-- '- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND'ra COMPLIANCE WITH
Recording ALL APPLICABLE CODES ANO ORDINANC.:S, THE ISSUANCF OF THIS PERMI i DOES NOT WAIVE
RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVr CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERPNITS REQUIRED FOR SE`'!ER, PLUMBING AND HEATING.
Total
By nN1 Op AGENT -- —
Approved Receipt No
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DATE ` INSP. TYPE INSPECTION REMARKS PLUMBING GATE
Contractor
2 7,_ — Permit No.
/a_ - Rou h-in ---------
Fixture
_ Final _
HEATING
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torNo.
Oiln —.—
!—
SEWER
Final - ---� --
JDRIVEWAY
Final
---Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
— Ar oach--- — _
BLDG.DEPT.FINAL JTEMPORARY a CERTIFICATE OCCUPANCY Final _
CERTIFICATF OCCUPANCY
Landscaping
Zoning Final
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Address Permit No. 1(3
Name of Occupant Permit charge
Paid by___
Date connected
Type of Building -L,(, Inspection fee
67,
Sorvice Bate— f) Paid by Date
Contractor Assessment— Paid
Size of connection 4e4