11040 SW 119TH AVENUE-1 -- 11040 SW 11.9TH AVENUE -_
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BUILDING PERMIT APf il-.ICATION FY TIGARD DATE-2zz/lL _ 19
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT I OR THE WORK HEREIN INDICATED BUILD ERPAONE_
I uR A� SHOWN AND APPROVED IN 1HE ACCOMPANYIfJG PLANS AND SPECIFICATIOPI:' UWNEirPHONE
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oww-H j`jjrk JOBADDRESS 1190; HOME ADDRESS
ARCHITECT
BUILDER SaMID ENGINEER
ADDRESS DESIGNER
STRUCTURE f3k-EW ^^_I�IREMODEL _DA'DDITION ❑REPAIR []RENEWAL ❑FIRE DAMAGE ❑DEMOI_I'TION
O RESIDENCE ❑C MM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PA'TIOl!)EAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND 01`10VING ❑CONDITIJNAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY--LAND USE ZONE BLDG.TYPE__ FIRE LONE_. PLAN CHECK BY_________ HEA'i _
CUnatruct car port tO bAisting house 18x20 This permit is ;jutJd -1rdy fur work 1,
w#thin property liners. —
0CC_L9AQ_ ...._._FLQQ 10200.
NEIGHL NO.STORIES AREA. NO BEDROOMS +LUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 12.011
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE 13UILDING CODE, ZONING
Plan Check 6.00 REGU'AT IONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DOt IE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE ,';ODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVEVANTS CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State TeX .54 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By
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-"-"" -' APPLICA 1 OR AGENt -
Approved Y TL1 __-- Receipt No ) I
511 177
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 999 DATE
PERMIT IS GIVEN TO
OE +r"L# r'
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICTAT
-
r
THIS PERMIT MUST BE POSTED O TN HE DESCRIBED
NECTION IS MADE AND PREMISES UNTIL CON-
PLF,TED. INSPECTION OF CONNECTION I1AS BEEN COM-
PFUMIT FEE PAID $....,?S4.14,
type•••••-•..........TIGARD SANITARY DISTRICT
R
CONNECTION INSPECTED AND APPROVF7)
8upeclntendent �--•—•--".
Addressl/Q9a ,r����f /y----- _ Permit No.
Name of Occupant -- Permit charge .
>M Connection fee_
- _...� Paid by--- ._..—.__.. .---.�._. ----------
nn nate connected
'Type of Building ! w _ Inspection fee./
Service Rate_____-_ _ Paid by Date
Contractor Assessment Paid
w
ISize of connection