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CITY 0 .IUYtk! 7ri1♦TG 007
BUILDING PERMIT APPLICATION TIGARD DATE -- t9—
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED OWNER PHONE —3L(31
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING
PLANS AND SPECIFICATIONS. 639-31101
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—�— ---- ---
ADDRESS BUILDER PHONE
OWNER
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NGINEER 1B
_ ARCHITECT DESIGNER
r1U11 DER
STRUCTURE ❑NEW 0 REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL _ ❑FIRE DAMAGE rSLAB ❑FENCE
❑DEMOLITION
❑ RESIDENCE []COMM ❑EDUCATIONAL ❑GOV'T 0RE.LIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE G
❑SIGN
QBOND LJMOVING ❑CONDITIONAL_USE ❑DESIGN REVIEW ❑COUNCIL APPROVED
HEAT
nCCUPANCY LAND USE ZONE _—BLDG.TYPE----FIRE ZONE_— PLAN CHECK BY_ —
— --- - — NO_STORIES___--___ AREA VALUE
CC
O .LOAD FLOOR LOAD —`HEIGHT__
LEFT SIDE RIGHT SIDE
REAR _
BUILDING DEPARTMENT SET BACKS_ FRONT _ —_ - —_--
Permit
— -- -- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND AL1. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL @E HONE IN ACCORDANCE WITH THE PLANS ANDSPECI!(CATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
� • '---I RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITU BUSINESS
T%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
• i
Total
BY —AF :ANT OR PGFNT
Approved Reef- ;.1 No PFI(7NF - -
-- ---- AOURESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor —_-
Permit No.
Rough-in
Fixture
Final _
HEATING
�— Contractor
' ----------- �-�- Permit No.
Gas or OSI
Rough-in
_ Final
_--Y SEWER
Final
DRIVEWAY
Final
Storm Drainage _
(Rain Drain) Final
Sidewalk
Curb&Street Final
_ A roach _
BLDG.DEPT.FINAL TEMPORA-71Y CERTIFICATE OCCUPANCY]Landscaping
Final
CERTIFICATE OCCUPANCY
I ( Zoning Final
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