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BUILDING FERMITAPPLICAI ION TIGARD DATE_ !3ep to ti�c3r 26 19 $3 4599
THE I-INDERSIGNLD HEREBY APPLIES FOR A PERMIT FOR i HE WORK HEREIN INDICATED BUILDE'i PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND 3PECIFICATIONS. OWNER PHONE --
OWNER Jay t.11e* tBl r. JOB ADDRESS 12185 ,T•? Kith LOT NO.
A ARCHITECT
ENGINEER
BUILDER Some P0 amdt2M ADDRESS ?.129DESIGNER
STRUCTURE P� NEW ❑ REMODEL 0 ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE U DEMOLI I'ION
S`RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOWT 0 RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB L.! FENCE
OCCUPANCY R- LAND USE ZONE BLDG.TYPE FIREZONE—/ PLAN CHECK BY —HEAT—'
Construct ains;la family Jwelting w!Attach*d garage
ti bedroom 2 TlathQ
SEWER PERMIT M- 26431 -- -------_---- _ gar.
OCC.LOAD FLOOR LOAD h1'1 HEIGHT NO.STORIES I AREA t'! NO.BEDROOMS ' VALUE
BUILDING DEPARTMENT SETBACKS FRONT '`� REAR 3?t LEFTSIDE it go RIGHT SIDE 1
3.34.!10 -------- ---- _--- ---
Permit THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN TME BUILDING CODE, ZONING
2 17*00 RFGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
551. 10 WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER.PLUMBING AND HEATING,
Skate Tax 1'!•3ti
SDC-
Total
DC-Total 664.G E 1 1(1(1.p11
- PDCM APPUCANTORAOENT
By dmj
Receipt No. _
Approved I! - — - --- - PHONC _.
6 ►7'E IINSP. TY INSPECTION REMARKS PLUMBING DATE
Contractor �Z
aA Permit
Rough in
Pixture
• Final
�. HEATING
Contractor
Permit No.
-- Gas or Oil
v -- - -------• Rauah•in - -
—i ---- Fines -- -
— - ---- - SEWER --
_ Final
-- - -- --- ----- DRIVEWAY _
Final —
Storm Drainage
(Rain Drain)Final
Curb&Street Final
----- �--' _—-- —- --- ` J �Fipnt.l
h - —
BLDG. DEPT.FINAL TEMPORARY CERTIrICATE OCCUPANCY CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
BUILDING PERM ITAPPLICATION TIGARD DATE_.'
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BI:,,.DER PHONE lid
OR AS SHOWN AND APPROVED IN THE ACCOtfPANYING PLANS AND SPECIFICATIONS. OW AER PHONE
:� -# LOT NO. n -:5-
OWNER
OWNER ���i�% JOBADDRESS
ARCHITECT
�/ y* ENGINEER
BUILDER ��H.� ADDRESS 1_ � _ cr .1.s.?9/ DESIGNER _.
STRUCTURE. NEW ❑ REMODEL ❑ AODITION— 7 REPAIR ❑ RENEWAL C3FIRE D;UAAGE C1DEtAOLITIOt
(]I-RESIDENCE ❑ COMM ❑ EDUCATIONAL L-1 GOVT ❑ RELIGIOUS ❑ PATIO ❑ CAR PORI ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCI
th:%uPANCY LAND USEZO E Y`1 BLDG.TYPE 5 �/ FIRE ZONE_=:::::L PLAN CHECK BY HEAT _
SEWER PERMIT y,Z t6''Yj .f / z _(f' -� ,dyW,,r
c.;A rte.e -f xs
OCC.LOAD FLOOR LOAD ' HEIGHT _iNO,STORIES / S1RE�A -r7 32 NO.BEDROOMS_ VP.LUCj` �,�;,
BUII.OINGDEPARTMENT SETBACKS FiOONT REAR LEFT SICE RiGHTSIDE
Pormit Z THIS PERMIT IS .S SUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZOWN:
"0 REGULATIONS AND ALL APPLICAAE-E CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TP..1
Pian Check ,c / ] WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANC
WITH ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIV
Subtotal -� �� / RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURP,ENT CITY BUSINES
LICENSE.SEPARATE PER.-AITS REQUIRED FOR SEWER,PLUMBING AND HrATING.
Slate Tax
SDC
Total -- — --- -- —
POCO APPIJCANT OR AGENT
By .
l .+pproved Receipt No. AODREss
E,,0 C
POC
SEWER CONNECTION S
SEWER INSPECTION S 3 - __
SEWER SURCHARGE S
1
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