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13820 SW 115TH AVENUE-1 13820 SW 115TH AVENUE N w U ro N ,tt 1 I v � ctnn e f, l� l) G/ c7 .77) rn V) u, r, n I F� � i-� r/j :n �� � I•� EA Ln C14 co to I City of Tigard INSPECTION REOUEST for +NSPECTION TIME :pkv iiv7f- PERMIT NO. . .. DATE. 226 `BATF ISSUED'__ OWNERS NAME * . ,A4 �T--- WDRESS : ���------- C,)N I RA CTO R :. - --- --- . -- ---�_-- RESULT Nppr,,aGd ,i..c- ,pru;aH SKETCH: i ri:AL c t j 5 moo, G _7? NSPECTOR DATE CVOTE . 9t;och 5upplcmentaf reret] I 9A, t" co �11 'Q z U ILI 1 ii �� t T � LU `�. > h 0 I h�+ CITY OF TIGARD 12420 S. W. Main WrW TIGARD, OR130N V= APP-KATION FOR BUILDING PERMIT New Construction F-1 Demolish C1 Addition ❑ Remodel ❑ Move C� ZONING _ DATE ISSUED _ BUILDING PERMIT BUILDING FEE $._1G��' No, '136 DATE RECEIVED PLAN CHECK $ By VALUAPIOtd $- O:^HER $ ---T5 TT_ RECEIPT No. TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION LOT w MAP A - CENSUS TRACT __- Jolt M Architect or Engineer /V?il? _5/Jy ___- - is/ _Phone1 Address.`. � 2U -!5w i/5 ------ — Owner [h� ------- --- - Address -._ ----.-__-- ___Phone Builder Phone ------' BUILD USE Single Res. ❑ Multi Res. ❑ :Omm. ❑ Industr OCCUPANCY GR0 No. of Stories Total Height__.___ Are Lot Type of Construction II III IV V Floor Area H-- 1 -_-._ 2��__ Set Backs: Front Back L.Side R. e_ Private Sewer Pipe Size-- Sew —��Septic Tank LJ water Service Pipe Size Stor we Ditch ❑ DryweI ❑ Street and Curb Requirements nriveway Width - �No. of Par':ing Sp Pj\RATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS ASSIGNED FIELD CHECK BY —_ �--__-•--DATE PERMIT APPROVED BY � -I It is understood that all work will conform with applicable codes and ordinances of the State of Oregon and the City of Tiqard, Oregon, and that the building will , not be occupied until a Certificate of Occupan�y s been issued by the City of Tigard Building Inspector. S gna re o i ant i, PERMIT TO CONNECT Tigard Sanitary District PERMIT" N�l 1629 DAT1T PURMIT 1S GIVEN TO � G.c.. :g -'� OF , TO CONNECT A TO THE SYSTEM OF TIGARD SANITARY DISTRICT AT s I THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON- NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM- PLETED. PERMIT FEF. PAID $.............` L)L I.............TIGARD SANITARY DISTRICT Byi f CONNECTIO� INSPECTED AND APPROVED Date — Superintendent ---- --V s t r Address 1384 S.W. 115th Ave. Permit No. 4w /lam 9 Permit charge Owner 2c,y c«LerConnecti.on fee 400 Paid by _ Columbia Custom Type of building Res. Date connected Service rate 3.00 per month Inspection fee �5 Contractor Columbia Custom Paid by same Date Size of connection 411 Assessment Paid i Ci I