12305 SW 127TH AVENUE 12305 SW 127TH AVENUE
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BUILDING PERMIT APPLICATION 1OF
1T TIGARD DATE19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE
LOT NO.__— ----.---.---
OWNERMIGN®l Cr"!) JOBADFJRESS 12305 SIS 127th HOME ADDRESS
ARCHITECT
ENGINEEP
BUILDER• MH*nury 1:anet. ADDRESS 649-1863 � —DESIGNER
STRUCTURE ❑NEW 1Q/*;imnDEL ❑ADDITION [I REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
(IRSSIDENCE ❑COMM ❑EDUCATI JNAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGF❑SI-AB []FENCE
❑BOND ❑MOVING UCGNDITIONAL USE ❑D''SIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY_. LAND USE ZONE_— _BLDG.TYPE FIRE ZONE- PLAN CHECK B'+'_—_ HEAT—__-..__ .-
w-ld 10xIH xoom ars exietlrty dwelliny all pear plane ai;d rude requireme6te.
OCC.LOAD FL4QB.LOAD ---.�LEISiFiL NO•�f_4H1E�--�iL .__ —1YO flE_RRDQMS VALUE.--- -
BUILDING
ALUE --- -
BUILDING DEPARTMENT SET BACKS ' RONT _ _ RE%R LEFT SIDE RIGHT SIDE
Permit .St.(]Cl � �_._.. _.._.r -- ..-
L0(;0(; THIS PERMIT 15 ISSUED SUBJECT TO rHE REGULATIONS CONTAINFD IN THE BUILDING CODE, ZONING
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Plan Check '• REGULATIONS AND ALL APPLICABLE L)DES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
W09K WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sllb-total A" CIO ALL APPLICABLE CODES AND ORDINAVCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESIRICIIVE COVENANTS. CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax U2 LICENSE. SEPARATE PFPMITS REOUIRED F)R SEWER, PLUMBING AND HEATING
Total ��•��
By
AdP►,ICAN1 OR AG77NT
Approved 6tW Receipt No
DATE II1:9P. TYPE INSPECTION REMARKS PLUMBING DATE
Contrmaor
_ t
. Permit No. — —
Rough-in
-- Fixture
------ Final i - -- -
HEATING Contractor
Permit
Permit No.
Gas or Oil
- Rough-in -- --
Final
— SEWER
Final
DRIVEWAY
_ 1�-- -- Final -
Stom Drainage
,Rain Orsini Final
Sidewalk
Curb&Street Final
Approach
E --
BG LDDEPT.INN NL TEIuYPORARY_—.__---- 7-ii-TFFiFATE OCCUPANCY
CERTWICATE OCCUPANCY Final
Landscaping
Zoning Finr!
� ! it�1�� �(` G: .i'�,� ,r'1�N�C r d>,•a�?��'ita,!��t '_
1n'
PERMI71 TO CONNECT r�
Tigf, d Sanitary District -�
PERMIT V1 1619 DATE / , 7 _
IIER511T IS GIVEN TO
TO CONNECT A_
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT_ l J ..ter r'a' 1•c t 7 ek _ --
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NFCTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
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PERMIT FEE PAID ;.. . .....�......................71GARD SANITARY DISTRICT
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CONNECTION INSPECTED AND APPROVED
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Address 12305 S.W. 127th Permit No . 1619
Permit charge
Owner Mr and Mrs Richard H. Milier Connection fee 400
Paid by male Construction
Type of building — Date connected,_.._2,f.-____
Service rate 3.0oear month _ Inspection fee�5*00
Dale Construction
Contractor Paid by
Size of connection_ 411
_____ Assessment._____r_„_—Pa i.d____
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