11650 SW 114TH PLACE 11650 SW 114TH PLACE
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BUILDING PERMIT APPLICATION CIT TIGARD DATEOF
THE UNDERSIGNED HEREBY APPLIES FOR APERMiT FOR THE WORK HEREIN INDICATED BUILDER PHONE_.1
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—.1¢-1..:_
LOT NO. _
11650 Sty 1),4 Ltt F l aCt Aw,
OWNER JOB ADDRES i HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER rr----tt ADDRESS DESIGNER
STRUCTURE ❑NEW 0.REMODEL ❑ADDITION ❑--REPAIR'' ++ ❑RENEWt�L ❑FI��RIEDAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSU1_FATI0 ,-AR PORT ❑GARAGE L_J STORAGE❑SL.AB OFENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑!?Ei IGN FIEVIEW ❑COUNCIL APPROVED USIGNS
OCCUPANCY____. LAND USE ZONE_-_____.__BLDG. TYPE _ _! IRE ZONE_ PLAN CHECK BY-- _ IaEn.r�_
Tn convert existing garage Into for ly room. No plumbin? - pro+ride combt.Tst lot)
air Lo fimnace rocim.
".C.-LQAP_.__ _FLS? LOAD HEIGHT.--. NO..$ZQHtL_._.___APf __.__►W,.6EUEJj0M.S VALUE-1 000, U0
BUILDING DEPARTMENT
SET BACKS FROST REAR LEFT SIDE RIGHT SIDE
Permit .— —__—_-__=_�=—_- ------ _---.__r� --- ---------` --�_
— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 0 REGULATIONS 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 WITH
Subtotal ALL APPL.ICABI.F CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
---- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 4% .40 LICENSE SEPARATE PERMITS REOUIRED FGR SEWER. PLUMBING AND HEATING.
Total 10.40_
By
APPI ICAN1 OR AGENT
Approved J. lett Receipt No ! ;'
ADDRESS -._ _ ro-N€" --- - ---- -
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It am ! o
SATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
l.� VCContractor
t No. _
Rough-in
Fixture
Finel
HEATING
Contractor
Permit No.
Gas or Oil
--- _ _.�._--- —— _ -- --- Routh - -- ---
-.— - -------- _ - ---- Final -
_ _ SEWER
Final
DRIVEWAY
Final
Storm Drainage
[JRa,, Drain) Final
_ _r'walk
b&Stieet Final
AroachBLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCYCERTIFICATE OCCUPANCY al
( Landscaping
— �. Zoning Final
11JILDING PERMIT APPLICATION COF TIC:ARD DATE` ,q Nd
- __
UNDE W� -,NED HEREBY APPLIES FOR APERMIT FOR THE WORK HE`iEIN INDICATED BUILDER PHONF __
LFi AS SHOVO4' AND APPROVED IN THE ACCOMPANYING PLANS AND SPFE-CIFICATIONS. OWNER PHOPIF_ _
N JOB ADDRESS �! .r�- ` �G • LOT NO.
4 ' _ Hptr1E ADDRESS
L ,J _ r� � ARCHITECT --
R._.--Y-�L~.-_N �„ADDRESS ENGINEER
�� _ _ DESIGNER
K'URE ❑'v_EW-- REMODEL—^ ❑ADDITION —❑RLPAIR []RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
1►NCE ❑COMM ❑EGI)CATIONAL ❑GOV'T EIRE LIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAR ❑FENCE
]HIIND _ ❑MOVING ❑CONDITIONAL USE _ ❑DLSIGN REVIEW— i13COUNCIL APPROVED ❑SIGNS
:•GUPANCY._._>LAND USE ZONE----_BLDG.TYPE _— -.—FIRE ZONE.__ PLAN CHECK BY HEAT--
f._ t.R9p_-- F19-QP_1.�9D_.--- - _. _ H ,ISLHL NS2. IARIES.. —AP_E9—.--A_►YsZ@FpP�9�lS__ /i�
_ BUDDING DEPARTMFNT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Flan (.heck REGULATIONS AND ALL APPLICABLE CODES AND OPDINANL"ES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
lh lo,al ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
k`--"— RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
tatf,Tax LICENSE. 5LPARATE PERMITS RFOUIRED FOR SEWER, PLUMBING AND HEATING.
Y
_- _-• App ICANi OR AGENT --___---
4z,prclved« Receipt No. -------- --•----�.�__
�►~ a Dlia E S5 6HOIV�---..----------
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.Address 11650 S.W. 114th Permit Noe_ 1505
Permit charge
Owner Connection fee 375.00
Paid by Jim Willock
Type of building Res. Date connected__ -22=.11
Service rate Inspection fee
Contractor Jim Willock Paid by same Date—
Size of connection 4" Assessment Paid