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PERMIT No.
PERMIT CHARGE !lone
Ci�.��NER /fc�-d �f� !�L _ _ CONNECTION FEE :S %.5-
PAID BY
TYPE OF B U I L D I N Gry��,Q,, t,��r___k____-�- 0 A i E CONNECTED
SERVICE BATF. ��_ INSPECTION FU
CfINTRAC'fOR PAIC BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
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1 -5-77
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CITY OF '11GARDY 5
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Bob Smith ................Y(.rmit No.... ...... ..
Owner*........ .................... ........
Building Address..........11990.. Sw.. Fl.e.z.olwood.....................................
` ...7.7...
Certificate is hereby given this........ .4......day of..........aanuary......,
that said building tnay be occupied and
` that it complies with all requirements of
ES
r,. • i Code for the City of Tigard, '
-� the Building .. �
as approved by the Tigard City Council.
.................
Building inspector
J fir.• i �.3 (al i"'s I;1 �o: w�r'�- i�;: .
1+'ri
City of Tigard
INSPECTION REQUEST
for
iINSPECTjr' TIME : � '`�'' PERMIT NO. '
DATE: .Q.. .. LATE +SSJEV:---j
OWN RS NAME : --
ADDRESS '
I �ONi. RACTOR : -- - -
TEST. Air C, 'Noter g , Visual ".. , �-nboratory J
I RESULT: Appr:,•vad n IL] PenJtng 0
I
I 1, SPECTOR DATE
ICOTE' Attach euppiem!,nt01 let! data here!]
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10618 k
UNI F D SEVVE. RAG AI:: Cr_NC� Y No.
WASH ! INUTOiN (,OUN 1 Y 1)A IE _- Auau , Q•19?b _�
C,i I Y O F_. __ Tigard
APPLICAI ION FOR SEWER CONNIFC-1-ION PERMIT f
OWNER: Nob Sriith
OWNER'S ADDRi SS:
SIREET
CITY S fAT' 21P
BUILDING SITE: I-OT BLOCK ADDITION _-En-ge-Luond _
TAX I OT NO. TYPE OF OCCUPANCY S.�Lig�e_�a►�_� -__�_.
A D D R F SS _H11.7-e-1- o o d Loop
DWELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE . WA._.__
PERMIT FEEINSPECTION FEE _$25....0DT0T.AL DEPOSITED _26M,0_0
(EXISTING) BUII DING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONINECTION TO THE SEWER SYSTEM.
LINE: SIZE . INSTALLER
RECEIVED BY _
(AGENCY OR ITS AGENT)
COMVENTS:
This Application and permit expaes in one hundred and twenty (120) days,
The amount paid will be forfeited should expiration occur.
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BUILDING PERMIT APPLICATION OF TIARA+ LATE. �U4t11>9t. 3�E_ 19_ 'r'_ � ' 7
297-2715
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR TNF WORK HEREIN INDICATED BUILDER PHONE,
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. C"NNERPHONE_ __._
L o,. J Lor NO.______. .r._._.
OWNER bob Smith JOB ADDRESS 11480 SU H&ZelWood HOME ADDRESS
ARCHITECT —
Same ENGINEER
BUILDER ADDRESS _ DESIGNER _ F 1
STRUCTURE ONEW 0 REMODEL ❑ADDITION ❑REPAIR ❑RENEWAAL ❑FIRE. DAMAGE IJDEMOLITION
❑ RRrE��SIDENCE ❑�FC--11OMM ❑EDUCATIONAL 0GOV'T [.IRELIGIOIJS❑PAT;O ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCF
LJBONU LJMOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNSLTLJ Gas
_
OjCUPANCY_—_LAND USE ZONE --__BLDG.TYPE __,_FIRE ZONE_ PLAN CHECK BY _ HEAT -
!..u+Istruct sinWlu family ewsllincj w sttauhed .4arnyu 2 etory�
d becirara bath
OCC'LOAD AHI A _ NO,BEDROOMS VALUE 369500
BUILDING DEPARTMENT SET BACKS FRON REAR LI F r SIDF. RIGHT SIDE
Permit
106110— THIS PERMIT It. ',SUFD SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING,
Plan Check REGULATION! AND ALL APPLICABLE (ODES MND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE GONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCF WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRV:TIVE COVENANTS. CONTRACTOR AND SLIB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 4LICENSE. SEPARATE PERMITS RFnUIRED FOR SEWER, PLUMBING AND HEATING.
Total 5152.74
By ETU --
AP NIT OR AGE VT
Approved ) --- Hit v lv N, ` 1
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ADDRESS _ HO
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