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14980 SW
109TH AVENUE
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ADDRESS PERMIT N]._ __.��_7 T6 `1
PERMIT CHARGE ^.J«e
UWtiEi� ,��;;� ��t�lJ CONNECTION FEE _ gi, w
PAID BY
TYPE OF BUILDING �yA&- a2. DATE CONNECTED ,
SERVICE RATE . INSPECTION FEE. -4s-.
CONTRACTOR PAID BY DATE
SIZE of CO�:'.ECTION ASSESSMENT PAID _
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BUILDING PERMIT APPLICATION of CI1�Y TIGARD DATE_. 12/26Z • ,9 `}
THE UNDERSIGNED HEREBY APPLIES FOR APEHMIT FOR THE WORK HEREIN INDICATED BUILDER PVIONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE
LOT NO.
OWNER 1'I(5,,.17 J1 JO F JORESS . ij HOME ADDRESS
-' - a113 ARCHITECT
ENGINEER
BUILDER g`ITli. ADDRESS _ _ DESIGNERrr•��
STRUCTURE ❑NEW_ ❑RI MODEL ❑ADDITION ❑REPAIR [:]RENEWALLJFIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE [:]COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO []CAR PORT ❑GARAGE [:]STORAGE JSLAB [:]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE []DESIGN RENEW ❑COUNCIL APPROVED ❑SIGNS
OCCOPANCY_. LAND USE ZONE -
_t1.=L_� BLDG.TYPE ,`, FIRE ZONE PLAN CHECK BY � _' HEAT__
-nnn}-r��r't nnaa ys_��1.4i)l nijOrtet®nt. W/t'��1*.4ga'ausss
all P61 1,18110 by van
11; ;e u r o Lr rm__-• L. bail t h e.
civ [l�Gjlnanc,! all bulidir)ue trork co0p.' stOci.
Iiaragui
Q&.LOAp-- FLOOR LOAl2 4G HEIC,tU__.1Q _BQ_51_Q 11E.$2 AREMS fir` VALUE-
BUILD!
ALU -BUILD!NG DEPARTMENT SETRcCKS FROrT REAR LFFTSIDE RIGHT SIDE
Permit �4,� .�3 THIS rt RMIT IS ISSUFO SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check .00 REGU� TIONS kND ALL 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
Sub•lotal jf ALL APPI ICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— --'- RE STR'CTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINIESS
State Text 7 j'4 LICENSE. SEPARATE hFRMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
rota) 4.,r n4 Pric it 2
By
��' --.-- APPLICANT UH AGI P,I
Apr,aoaa �:,I 1 ter? Receipt No. ,
IMINE f ■'
REMARKS PLUMBING DATE
DATE �INSP. TYPE INSPECTION --- -- ----
Contractor
Permit No. �------- --- - ------
aou h•in
-
- Fixture
Final
HEATING
C -Vractur
-- - - Permit No.
�— as or Oil
Rough-in
- r ---- Jj-----
- Final
-- SEWER
-- — - — Final
"-- -- _-- ovivEWAY
Final
-' - Stonh Drainapa
--- - -------- --- - (Rain Drain)Final
__ ----------- a Sidewalk
- - Curb St.eat Final
Approach
BLDG. DEPT.FINAL TCM1 ORARY CERTIFICATE OCCUPANEIf Final
CERTIFICATE OCCUPANCY jX�
/ Landscepinp
Zoning Flnel
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�JILDN'G PERMIT APPLICATIONOF I C,1,R,DDAT E
HEREBY APPLIES FOR APFRMIT FOR THE WORK HERFM fNDICtT[D F3UILDE:RPHONF-__
-'-N :-ND IN T E ACCOMPANYING PLANS AND SPKII`iCAlIOr%S.
K OWNER PHONE.
L OTeNO
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ADDRESS ENGINEER
DESIGNER
Vy ME MODELA 0t;I T-ION REPAIR N�VIA L EIFIRE DAMAGE ❑CIDEMOLITION
DECILICATIONAL [:]GOV'T 13FIFI-GIOUS0-P.
-TIO CICARPORT rhARAGE OSTORAGEOSLAB [IrENCS
r, N[) UCONOITIONAI USE
0DESIGN REVIEW DCOUNCIL APPROVED
OSIGNS
ZONE
IRE ZONE__ B
PLANCHECK Y.(
HEAT-12a-o
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N �§T_QLfjLE5__"2— Aff!E�F,3_�?ejkC
LQ )j.-p VA6QVZA-0,r(;
1011LUIN,., OtPAHIMENT
SET BACK"S F RONT- c-I E A EFT SIDE
RIGHTSIDE
Check THIS PERMIT IS ISSUED SURJECI TO THE RFGUl A71ONS CONTAINED IN THE BUILDING CODF.. r'ON114G
RFGULATION6 AND ALL 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 k'VITH
.01 ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVSNAN1S. CnNTRACIOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSIWS
LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, I'LUMRING ANO HEATING.
APP, ICANI OA
-d Fleceipi No
60
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