12235 SW 125TH AVENUE �I.
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BE,LDING PERMIT APPUGATION 10 Y TIGARD DATE__— '19 �417
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INLICATED BUILDER PHONE —•
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE'
LOT NO.
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1 t'i:,!'!1"i� � ,tiIC�CA it] Z- Hr�1.1E ADDRESS
OWNER JOB ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ❑NEW C3 REMODEL �-1 ADDITION C3 REPAIR ❑RENEWAL CjFIRF. DA601AGE ❑DEMOLITION
❑ RESIDENCE ❑COMM_❑r-DUCATIONAL 0GOV'T ❑REI_IGIOUSGPATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FEPJCE
❑BOND ❑M_VIIVG GCONDITIONAL USE C3 DESIGN REVi%N :.1000NCIL APPROVED_ ❑SIGNS
OCCUPANCY LAND USE ZONE _,—BLDG.TYPE_ FIRE ZONE___ PLAN CHECK BY_—_------ HEA1
•tjat, me ur.r.r..k a/a beatelatear all Par rude requr,wAn LL.i. L1tsrPLJ"C%- _
—_ < AREA _dS2�flED�3QQA�. VALVE
45�.14AD_—._—_�lQ (�1�oAD
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BUILDING DEPARTMENT SET BACKS FRO ' REAR LEFT SIDE RIGHT SIDE
Permit :a.
— THIS PFAMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILD KG CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11 IS HEREBY 1641gEED THAT THE
WORK WILL BE DONI< IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NO' WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
5'ate Tax '1`5 LICENSE SEPARATE PERMITC REQUIRED FOR SEWER, PLUMBINC AND HEATING.
Total 5•
_ A (CANT JR AGENT
Approved T Receipt No
ADDRESS ---.. ----------- r I u LaF