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11375 SW LAKEWOOD COURT
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City of -711go(d
flON RE"'.1EST
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IN1PECTION TIME . PERWT NO. 0
DATE
�Z DATE ISSUED
OWNFRS NAME A5G0' 4ec,^
ADDRESS:./ , "' f
CONTRACTOR .' ---.—
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City of Tigard
INSPECTION REQUE a
for
INSPECTION TIME: _ PERM11 Wo
DATE . 1L_? Z6. DATE ISSUED
0WIN FRS NAME
ADD RES S:"Z 010
CONTRACTOR
TEST .' Air [], Water [] 'Visual �, Laboratory ❑
PESlR.t'. Approved. Disapproved ❑ P_nfinq [j
SKETCH,
INSPECTOR nAT
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ADDRESS
'3 d�d�t, PERMIT NO. ef 4.5
PERMIT CHARGE none
OWNER C 3 N N r r T I O N FEE
PAID By 1!5�
TYPE 0 F 13 U T?_0 1 N G 2—.z, DATE CONNECTED
SERVICE RATE
INSPECTION FEE
r c t4,r R A tJ DR PAID [3y DATE-
SIZE Of' CONNECTION ASSFSF)MENT PAID
City of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME : �� � PERMIT NO. : -
DATE: 11X1Z7L DATE ISSUED:_1
OWNERS NAME :
ADDRESS
CONTRACTOR :,___ _
TEST: Air p, Water , Viauay� , Laboratory []
RESULT: Approved , Disapproved O , Pending r]
SKETCH:
SPECT DATE
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CITY OF
BUILDING PERMIT APPLICATIO14 TIGARD DATE 7t-1 - 0611
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THE tJNLcRSIGNED HF EBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR .4S SHOWN AND APPROVED) IN THE ACCOMPANYING PLANS AND SPECIF'I�yA►TIOjyS. OWNER PHONE_ _-
OWNER, ob SmithLaaka w aLi <,
ADDRESS B JILpF.R PHONE
ENGINEEF'.
Owner ARCHITECT DESIGNER
BUILDER - —---"'"-
STRU7TUHE ❑_NEW _ ❑REMODEL. ❑ADDITION ❑REPAIR ❑gEYEWAL ❑FIrPEDAMAGE ❑DE_dOLITION
❑ RESIDEN':E ❑COMM ❑EDUCATICVAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARJ 9E ❑STORAGE❑SLAB []FENCE
BOND ❑MOVING [ -.r-DITIONAL USE ❑I)ESIGN REVIEW ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY_ LAND USE ZONE ii-7 BLDG.TYPE_- FIRE ZONE_3 PLAN CHECK BY—= HEAT
is
constLuct 1196 Ziq. Ft. free@ dWawiling w.Lth attralrhed 9*yag*
-- 1-,o basement reissue lot 79p Ole 38 40 ---
OCL•LOAD FLOOR LOAD — HEIGHT NO.STORIL3 3 AREA VALUE
DEPARTMENT BUILDING DEPAr� 1
_ SET BACKS FRONT REAR LEFT SIDE __—RIGhIT SIDE_ _
Permit
---- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATION, CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL .APPLICABLE CODES AND ORDINANCES, AND 11 IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PL.P`NS AND SPECIFICA"TIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RE87RICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT i.;TY BUSINESS
1%5tate LICENSE. ScPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total j tl.iia
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By
APPLICANT OR AGEN1
Approved 1 Receipt No.
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ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING -- DATE
� — Cr,ntracto►� 2�
�.. �� Permit Na. S
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Rough-in —
r/ V Fixture
I�3/-7 /"�a4 _ .!a Final —�
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HEATING
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Permit No
Gas or Oil
( Rough-in
/ c — Final
SEWER / iy'Jm ,
•_ — �__._.___--- Final
DRIVEWAY/-4.�
0.7b7
--— ----- --- Final -- ----
Storm Drainage J_
--� _—___ ---------- JNCY �,
ain Drain) Final _ _
-- dewalk
urb&Street Final
— •—_-- --.____— _ pproach^.�
-DG.DEPT.F Ay --TEMPORARY CERTIFICATE OCCUPA17 — .J CERTIFICATE OCCUPANCY andscape g
oning f final
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