12555 SW 124TH AVENUE i
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CITY OF TIGARD
I 12199 S. W. Maln Shoot
TIGARD, OREGON 97997
APPLICATION FOR YUILDING PERMIT
New Construction a Demolish ❑ Addition ❑ Remodel ❑ Move ❑
20NING A-7
DATE ISSUED 7-30-73 BUILDI .G PF cMIT
DATE RECEIVED
BUILDING FEE $ 59Q
PLAN CHECK -7a.$ 2•50 —BY VALUATION $ 200.00
OTHER $
72
TOTAL $ 7,SO RECEIPT No.
— -7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT _ _� _ _ MAP M_ CENSUS TRACT _ , __ _ JOB M
Architect or ]Engineer_
Address----- ------Pho,ie____-
Owner Hr.war& Becker —_-- --___-- — -- __
Address ,2,,: ;.w ,Myth Ave --------- Phonc ,--- -
euilder --
Address --- --Phone -
BUILDING USE Single Res. ❑x Multi Res. ❑ Comm. ❑ IndustrialL_.'
OCCUPANCY GROUP _ No. of Stories—_ Total Height___— Area of Lot
Type of Constructien I I1 III IV V Floor Area B _ 1 2
Set Backs: Front.---.— Back L.Sida R.Side�_
Private Sewer Pipe Size Sewer _ S_ptic Tank ❑
Nater Service Pipe Size_ Storm Sewer ❑ Ditch ❑ Drywe11❑
Street and Cur)) Requirements_
Driveway Width —� _ No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND .-LUMBING
SPECIAL INFORMATION
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ADDRESS ASSIGI)ED,_
12555 S.W. 124th Ave.
FIELD CtIECK BY _— B►C _ _^ _.�____ _y.._DATE_XAM 7-30-73
PERMIT APPROVED BYA�-,7 - ��
k will conform with applicable codes and oes
It is understood that all work pF
of the State of Oregon and the City of. Tigard, Oregon, an(l that the building wil
not be occupied until a Certificate r,f occupancy has been._issued by the City of
Tigard Building Inspector. r
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Address /aJ5 .5 Permit No.
Permit charge
Owner Connection fee_ 37S. =-
Paid by
Type of building r „ Date connected---.Z-7-7
Service rate Inspection fee_ 40
ContractorPaid by Date
Size of connection '' Assessment Paid
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT
N° 1392 DATE _ / .. .�. ,�
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PERMIT 1S GIVEN TO
OF
TO CONNECT A r'
TO THE SYSTEM OF TIGAR;1 SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS 'MADE AND INSPECTION OF CONNECTION HAS BEEN COW
PLF.TED.
PERMIT FEE PAID ;.._ _............................TIGARD SANITARY DISTRICT
BY
CONNECTION INSPECTED AND APPROVED pp�{
Dite
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