11180 SW FONNER STREET 11180 SW FONNER STREET
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for iri;<I)ectiaatm call 639-4&
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BUILDING PERMIT APPLICATION TIGARD DATE 19_. _.
111E UNDERSIGNED HEREBY APPLIES FOR A PFIRMIT FUR THE WORK HEREIN!NDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SrECIFICAT10ki.s. OWNER PHONE
.fan reamlct- IllbO SW F mae�r LOT No.---
OW61ER JOB ADDPESS
Niv Const. b ycc. 4580 SN 185th ARCHITECT
bpcc. ENGINEER
BUILDER - --- - AIS__-- -- Bvton 97001 - - DESIGNER
J `-------- - ----
STRUCTURE NEW ❑ REMODEL ❑ ADDITION T ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
Qj RESIDENCE Li COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ;] PATIO 11 CARPORT [Y GARAGE ❑ STORAGE ❑ SLAB FENCE
OCCUPANCY LAND USE ZONE ----_BLDG.TYPE -�! -_FIRE ZONE._ PLAN CHECK BY - HEAT-..----
Construct
EAT_.._Construct detucheti rage
SEWER PERMIT N
III leer left ..ie
OCC.LOAD FLOOR LOAD 50 1bNEIGHT 1%0.STORIES 1 AREA 111(M NO.BEDROOMS VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
86.50 --. _ _ .- -- - - - --- — - - - -
Permit _ �� THIS PERMIT IS ISSUED SUrjECT TO TH-- REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
56.23 REGULATIONS 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
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Svb-total _ 142./3 RESTRICTIVF. COVENANLS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 3.46 �►« I LICENSE.S pd R`'1:3 J?ERMITS REQUIREf%EOR SEEWEr PLUMRINO AND HEALING.
- - - — 4 3t III.-
SDC
1 / k3J i
SDC—
Total 146.19 _
By bAJIUR J 10.14 PDC# APPLICAN 0 AGENT
A r ' Receipt No
ADDRESS
-- ----- -
Pp � '`^�„ PHONE
DATE JINSP.1 TYPE INSPECTION REMARKS
F&.UMBINC9 DATE
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Contr&ctor
or
ot/z I,Pwrri NL
Rough-in
Fixture
Final
HLATING
Contractor
Perm,t No. 14
Gas or Oil
Rough-i-i
Final
SEWER
Final
DRIVEWAY
rinsi
S(arm nrainap
(Rain Drain)Final
Sidewalk
Ct rb&Street F-nel
Approtch
r.LD(.- DEFT.IF: AAL CE q TIrIZAA-C-.'0i5C-4,A—rIcv—
CERTIFICATE OCCUPANCY I nel
I ko4maping
'n-Ing tinal
INSPECTION NOTICE
(,ity of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Date Requested Time A.M. P.M.
Address
7
Permit
Owner Lot #
The following Buiiding Code deficiencies are required to be corrected:
Presented to Approved
Inspector FJ Disappro,-ed
Datf.
CALL FOR REVVSPE--TION
D YES 2f NO
SEWER PERMITUL�;,.►
Unified Sewerage Agencyof Washington County CITY OF _ DATE
0'.1 N E R : ___ ,��- �-►4Le,r P H 0'V E :
OWNER ' ; ADDRESSOfjo:__ _
TYFE OF INSTALLATION:
ZKBUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
�TYPE OF OCCUPANCY,
NEW SINGLE FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO -7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTU;E UNITS DWELLING UNITS_—../ _�
ADDRESS OF STRUCTURE :
PERMIT CONDITIONSs THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
PEGULATIONS OF TH UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECYION,
PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE—
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED ShUULO
EXPIRAT;Or' OCCUR .
FEES:
PERMIT FEE $ �_
CONNECTION CHARGE
SIDE SEWER INSTALLATION
ISSUED BY
OTHER
TOTAL $ �.
(cp —_ — -------- — --..._—_
APPLICAr ' DATE
SEWER PERMIT N°
ADDRESS OF STRUCTURE _L/_L_8-U Foji M or 9
TAX MAP ZSr" /JC.. i _ TAX LOT _ ���� SYSTEM
LOT BLOCK OF
APJfPOVED BY DATE ISSUED BY DATC
D- 1). ' S z REMARKS
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-for
INSPECTION TIME * PERMIT NO.: -- -
DATE,
O.: __DATE' DATE ISSIJED'_L__L�
OWNERS NAME ' ---
ADDRESS :
NAME ' __ADDRESS :
CONTRACTOR :------ —
TEST. Air Cl , Water p , YXual O , r_aboraior•y ❑
RESULT. Approved zK, DisapV-oved Li , Pending ❑
SKETCH:
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I Pidpr CTOR GATE
ICOTE : Attach supplemental tett dat, ,herst.10
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