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BLUING PERMIT APPS Y ATION Co Y TIC ARA DITF____9._A5 „.7'__ 11157
THE UNDERSIGNED HEREBY APPLIES I UR ” EM411 FOR THE WORK HEREIN INDICATED BUIt-DE"?PHONF.,Ir�9WI M..
OR AS SHOWN AND APPROVED 114 THE A� .1MPANYINC- .-_ANS AND SPECIFICATIONS. OWNCRPHONE_ JJ�7�'aV'�
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OWNER j08>11S J _ JI.1L) J' , E F,�ti J I)�.•
x)B AOC'RESS HOME AD7RESS
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r,UIL.LiFN ADDRESSS11 JESIGNCR _4 !_ _.___
,;TRI.,-TURE ❑NEW REMODEL LC�ADUITION ❑REPAIR `❑NENF.WAL ` ❑FINE DAMAGE (]DEMOLITIONE3'11 ;.IDENCE ❑COMM DEDUCATIONAL L IGOV'T ❑RELIGIOU5❑PATIO ❑CAR PORT ❑GARAGE E STOHAGE❑SLAB ❑FENCE
UPOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ECOUNCIL APPROVED ❑SIGNS
r22CU,°'1NCY —LAND USE ZONE. f� —BLDG.TYPE__ -_FIRE ZONE--APLAN CHECK BY—ET. HEAT !',
Cinsto an addition to rear of wristing ducIlIng ')x23 and 796"x 38e
�Rll work per c,Uilds>'9 cr,drm
NEIS�NS_—. - � I931 �1--SHA dS�BEQf3QQb
i� BUILDING DEPARTMENT SET BACKS FRO IT REAR LEFT SIDE RIGHT SIDE
Perm t 32*CG �—
THIS PERMIT IS ISSUEI'i SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDIIJG CODE, ZONING
Plan Check IO•nQ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
— "-�— WORK WILI BE DONE IN ACCORDP.NCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb-total� I ALI APPLICABLE CODES AKS ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Jl RESTRICTIVE COVENANTS. ;ONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERM'I'S REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
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Approved _ �~ Receipt f o.
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Address 9380- 3,'W, Lake St. Perm+t No. 1468_
Permit ^harfre
Owner. Connect i.on fee 37: .00
Paid by__
Type of building_ ics, Date connected_ 10/23/71-
Service
0 23/71Service rate i • per monti` Inspection fee_2 .00-
Contractor i. C,. " 1 Paid by_ Date
Size of connection 411 Assessment Paid
r
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 1468 DATE
PERMIT 1S GIVEN TO ?
+
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT ,1.
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID . .. .........................TIGARD SANITARY IDI!-TRICT
9 fr
-MANVM/v11d
CONNEI,'TION INSPECTED AND APPROVED
DAte Superintendent L