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BUILDING PERMIT APPLICATION 11 Y TIGARD DATE___ __ _ Y
,s 2 �!�-
fHE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF _
OR AS SHOWN AND APPROVED IN THE ACCIRAPANYING PLANS AND SPECIFIC,ATIONS
LOT NO.�
OWNERPHONF
—
jt t i C CiC_EJI I LV�. l
OWNER --
•--- JO6 ADDRES—S
- HOME ADDRESS
ARCFIITECT
BUILDERADDRESS ENGINEF:P
_ DEZLGL ER
STRUCTl1F;F ❑NEW ❑_FlF'MnDEL ❑_ADDITIU_N ❑_REPAIR _ ORENEW�A,L QF-IRr_ DAMAGE CIDEMOLI'TION
❑ RESIDEN FQ
_ COMM OEDCICATIONAL� QGOV'T ❑_RELIGIOUS IIPA1'IO_❑CAH PORT L UGARAGE ❑STORAGE�SL ALS [JFENCF
Il
r BOND - ❑MOVING_ ❑CONDITIONAL USE -❑DESIGN REVIEW
--�C�COUNCIL APPROVED_ �OSIGNS
UCCUPACY--___-LAND USE ZONE___ BLDG. TYPE—'- FIRE TOiIE�_PLAN CHECK BY_ —y
'i' ' !'r'• - �.;)' �W16f.".1: :.th:i WIAt;'1, ILLadied
---- HEAT--- -
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BUILDING DFPARTMENI' �N2flA5'Q4ld -
–E:_--- SETBACKS FRONT REAR I EFT SIDE RIGHT SIDE
Permit — _ ------- _--R'_----
Plan Check Y� THIS PERMIT 15 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
°' A REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND ff IS f1EREflV AGREED THAI THE
Sub total WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
ALL APPLICABLE CODES AND ORDINANCES. THE IS5U.40ICF OF THIS PERMIT DOES NOT WAIVE
State Tax
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY eUSINFSS
LICENSE. SEPARATE PEPIAITS REOUIRED FOR SEWER, PLUMBING AND HEATING
Total . Y
By -
-
A PPUCANI OFl
Approver' _ — Receipt No
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor —
PermitNo�4 ,
Rough-in
�=77`79 1
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/e/1_ f✓ M�.,s 0" s{I�'�t'h AOLHftFI �• Fixture
Final
HEATING
Contractor
PermltNo. �Y ��SY Q`�`?Q r►' �^
(•3-BL P�Rtio+�w�ur _eh Fi„� C� ? 1 _ Gas or oil U
g to gL �,,,�A�1t �!>�ir�vt {—�W►7�' ji l���l��QitOst����3y� Rough-in —
.. Final
•L�tL— �' _-- SEWER
inal
DRIVEWAY
Final
Storm Drainage ---'— —� -
(Rain Drain)Final.
—� — Sidewalk
Curb&Street Final
_ Approach
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BLDG. DEPT.FINAL TEPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Len i, aping
Zoning Final
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