15755 SW QUEEN VICTORIA PL7' ....
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BUIL D G PERM'T APDL!CATION '�.,-411gia .,tA AVICIATE , d;17I J() , 19 /.4 N0
PORTLAND,OREGON 97223 6
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SH WN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFI ATIONS. OWNER PHONE
OWNER b;La.. a g,, '4 ADDRESS / c?c%Y sc� i -LC4 s; BUILDER PHONE
'7 ., ENGINEER
BUILDER 1"9/A.C.‘- .Lt '7,14../"C/",-""- ARCHITECT DESIGNER
STRUCTURE ❑NEW ^^0 REMODEL OOFIRE REPAIR RENEWAL ;AFIRE DAMAGE ❑DEMOLITION
,RESIDENCE 0 COMM OEDUCATIONAL ®GOV'T ❑RELIGIOUS DPATIO ❑CARPORT ❑GARAGE ❑STORAGE GISLAB OFENCE
(BOND 0 MOVING OCONDITIONAL USE 0 DESIGN REVIEW ❑COUNCIL APPROVED ESIGNS
OCCUPANCY LAND USE ZONE $LDG.TYPE FIRE ZONE PLAN CHECK BY HEAT
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OCC. LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE Off
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit I� Ci, C)CJ
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check I REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording 11 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
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1 7 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total i, 7
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'I APPLICANT OR AGENT
Approved 1� C j < 9 Receipt No.
ADDRESS PHONE