13360 SW 121ST AVENUE w w N u rMIA
13360 SW 121ST AVENUE _
BUILDING PERMIT APPLICATION TIGA;�") DATE
THE UNDERSIGNED HEREBY AFPI.;ES FOR A PERMIT FOR THE WORK HE�EiN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE s;9-07ic
s T LOT NO.
OV'+'PER ��_`�r� �' ,,,�Hwy� Safe ADDRESS / �.,�v O �S,Gs%✓ �' > --��
ARCHITECT
ENGINEER
BUIt.DFR f /�/�if'l7C/i ' ADDRESS �y'��c> /t/���'z.-2 9! - DESIGNER
STRUCTURE O NEW WREMODEL ❑ ADDITION ❑ REPAIRd RENEWAL h ❑ FIRE DAMAGE ❑ DEMOLITION
® RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ ST'JRAGE C SLAB❑ FENCE
OCCUPANCY ,��"^-� LANG USE ZONE ✓'� BLDG.TYPE FIRE ZONE__ PLAN CHECK SY
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SEWER PERMIT N
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AhEA NO.BEDROOMS VALUE �•' r
BUILDING D+_.PARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
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Par-nit THIS PERMIT IS IS.SUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZON!NG
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TF'.E
Plar.Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
lSutrtotal _� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING,AND HEATING.
1 State Tax
Total LIZ
Pres APPUCANT OR AZENT�
BY !7
Receipt No.
Approved ADDRESS NIONE
DC t
DC S _
EWER CONNECTION $
EWER INSPECTION $ _
EWER SURCHARGE S�
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R. T. MILLER ENGINEERING INC. `� i �I D�) 1n C��I Or
CONSULT9N41 STRUCTURAL
100 CONCOND SLOG PORTLAND, Ow SGON 07104 /
i SOS) 248-1055
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APPROVED FOR CC+JS"i Rt.:u1'I0N 4
CITY OF TIGARD
PERMIT NO.--V S!T' ADDIRErSS__/_.�,3
BY �'/ �f I f`1F_ _ ._.__ DA i E C 7-
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