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15380 SW 116TH AVENUE
KING CITY
BUILDING PERMIT APPLICATION 10F TIGARD GATE u-1®-?
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE-----..'&—
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFIC,ATIONF OWNER PHONE-
LOT NO.— --�—
OWNER t' )r2i�n JOB ADDRESS HOME_ ADDRESS _
ARCHITECT
15,711141 Lt.mi Ili i14 EIJGINEER
BUILDER ADDRE[S--yS _ DESIGNER _
STRUCTURE ❑NEW ❑REMODEL DS
❑REPAIR OFIFNEWAL OF IRE DAMAGE ❑DEMOLITION
O RESIDENCE ❑COMM ❑EDUCATIONAL 0GOV'T ❑RELIGIOUS CIPATIO ❑CAR POR[[--T�� ❑GARAGE ❑STOFIAGE QSLAB [:]FENCE
CIBOND ❑MOVING ❑CONDITIONAL USE GDESIGN REVIEW L_1COUNCIL APPROVED ❑�,IGNS
4CCUPANCY_._LAND USE ZONE_^_ _BL.D(j.TYPE---.F IF([ZONEPLAN CHECK BY HEsAt____,__-_-_
eign and concrote wall structure
QCC LOAD FIL Qf-( QAI-_._- HEIGHTN _11QRI15__.___._ASE$- _ - ____N9_1LU iQ4M$—
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 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 AN17 IN COMPLIANCE WITH
Subtotal ILL APPLICABLE CODES AND ORO!NANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax I ICENSE SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING ,TND HEATING
Total
By
Agot_ICANT OR A(iENT -__- - -- -
Apploved )IJ I(,t t I,l No _ --
A[�GRES9 PNOfvE
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