12500 SW 124TH AVENUE r� `i- ►• r
A 'NUE
SW 124TH V�,
:r.
4-3
Ln
ci
J
• •r S
4•'
r
w I'
b
i
1.
� T
BL .DING PERMIT APPLICATION CIT OFY TIGARD DATE —> cat�i,Jtat r''R
x 7+F Y
THE UNDERSIGNED HEREBY APPLIES FOR Ar =RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONr
LOT NO._
OWNER JOB ADDRESS HOME ADDRESS
ARCHITECT +�
ENGINEER
BUILDER_ ADDRESS _ DESIGNER
STRUCTURE El NEW 1:1 REMODEL ❑ADDIITION ❑REPAIR ❑RENEWAL OF IRE DAMAGE ❑DEtif��L.ITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T DRELIGIOUS[]PATIO ❑CAR PORT ❑GARAGE ❑STORAGE ❑SLAB ❑FENCE
❑BOND ❑MOV ING [:]CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCII. APPROVED C13IGNS
OCCUPANCY. ' LANY LANUSE ZONE BLDG.TYPE - FIRE ZONE_ PLAN CHECK B'y SEAR.►
c: , t._ x 11 ;firWOALJ110rT Lj axtati,nu dwellin. --
I
7 rear or
L_-------NU>F�ED_RQQr0S------ VALUE !-
BUILDING DEPARTMENT SET BACKS FRf+N1 REAR I f I t 1101, RIGHT SIDL
Permit --- -
- -- THIL P:RMIT IS ISSUED SUBJECT TO THE hECULATIONS CONTAINED IN THE B,'ILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND iT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCGRDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUIT-total ALL APPLICABLE CODES AND 7RDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
"'-` RESTRICTIV'- COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. ;EPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING
Total
By
APP+ Il.AN 0P AC1t NT - ----- -- -
Approved— 11,(eISI N(-
S 7
S
r
+
EL
l
f
i'
R
e
�L/moa
GZ
1
i el � w = LL n
7 U Z x > W
° zl "v z ~ 3cz
(` ~ w Oh w 'yN
�y CII �L w� zozm
d
on � t
W N U
of ❑ Cl 2 > UO2
Lu
2Luu z �mo � a o
z i a <� u�
(� O a ¢ ¢ w w a w w z Q
VI o. T u Q O f 2INn
w Z O IA C) � NQrAC Q
Lh p r, w r�1 _
l� J LL Ul ❑
%L
a
O m r, U. °� a� uj z
I �I 6a > a
oc I ? v° oz
O N Q r m w FNww1v. 0
Fz a y w ° zuNzci
O O Q
O U LLI yZ KZj
W CA _
`— LL w LI at a j• uj
1 x r, N `agxcw
u, u i I
u �� a w JCld �
I
O O 1 w of y h eC W 3: Q 0 r
Y > Z O wQC
T w O acl
O to V a O a: N 2 f US� _z0 L
ul
z ul
w O� V ¢ � °, - n
g
W N 1i ? C OFO u
F a I ( CJ C 1 i
F p z O C) I � a0Cu � 141 c
� QD
LL } Q U O N a u H
W W Hf Z W W � ZOOad
LL d z x O m UuO� � WC7W W I
a U 4 w Q C) J F r `' W Q N < OwiOQ
C)
Q J _ c � � m �� 1
Q Ir > a uln
z a .�EW
a �1a4aWr � cy
Ct- Qul Cl -
} O 2 Z w
u Q U N o ul
o
r~' z d L" to ul tr
��. n �.li >I o cf
L ! w > O ? C,. x --
CL .� z O $ d � as ,
CI v ( I J ci
u o
C l -�, N u v n
. I _i Q u G a r a C, u
CCl I U LtI
C, Q wl a' o v O E c to
i
PERMIT TO CONNECT
Tigard Sanitary District
i� q .3
PERMIT N? 1504 DATE 6, -
PERMIT IS WEN TOOb
l
TO CONNECT A 4-
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
Al f 2 S ; -�-'Lt�} j 4 ZTHIS PERMIT MUST BE POSTED ON THE DF-RCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSFECTION OF CONNECTION HAS BEEN COM-
PLETED.
r l7
PERMIT FEE PAID t}....3...�.. .... '�....TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
Dete Superintendent —�'
i
I
i
Address Permit No._ /5e-)x
Permit charge
Owner .__ Connection fee
Paid by
Type of buildings. Date connected
Service rate _ Inppecti.on fee '
(�
Contractor l_�Cf y � Paid by Date—
Size of connection �" Assessment Paid
F
`F
k