Water Resevervoir 141st Avenue & Hi Tor Drive - Building Permit PE a
BUILL*m"G PERMIT
WASHINGTON COUNTY BUILDING
ADDRESS
DEPARTMENT OF PLANNING
LOCALITY
BUILDING DIVISION NEAREST
CROSS ST.
CENSUS LAND USE GROUP TYPE PROSED BY
FOR APPLICANT TO FILL IN TR. CODE CONST.
BUILDING sr STATISTICAL CLASSIFICATION Z&E J
ADDRESS
CLASS NO. DWELL UNITS
LEGAL DESCRIPTION -ta SPECIAL CONDITIONS
l
AREA OF LOT NO. OF BLDGS.
NOW ON LOT 124 j
USE OF ZONING APPROVED BY ,. DATE
N
TEL. TYPE OF SANITATION DIST.
OWNER
ADDRESS Pelyl SW WATER SUPPLY DIST,
BLDG. SETBACK FROM
CITY 6�/ FRONT PROP. LINE OF (STREET)
Aa.QHIT TEL. TYPE OF EXISTING. SETBACK HIGHWAY -F YARD = TOTAL
ENGINEER NO. HIGHWAY WIDTH FROM C.L.
ADDRESS (� � 'F = J L
L, BLDG. SETBACK FROM
CONTRACTOR NO SIDE PROP. LINE OF (STREET)
TYPE OF EXISTI�11SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTHFROM C.L. }.
CITY ____+._..� = C-
O
DESCRIPTION OF WORK - CORNER CUTOFF YES E NO W
W
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES ^` FAMILIES W
�5S— �/'77^� EADCAGpF(jc,�, a
NO. BEDROOMS NO. OF BATHROOMS ITIS A: P� T10� A BUILD[ G PER�AL
WHEN P P RLY FILLED
USE OF T NED,4A D V L D FO TC RREC [pYEpKp�1 F
''� ��'gp�•��IrDATION�S FfACE BELOn iPEMI TH ER EFO GRANT
STRUCTURE s�E"GA1 r- � c-
ED TO DO SUCH WORK AS INDICATE 15 APPLICATION, IN
NO. OF EMPLOYEES ACCORDANCE WITH, AND SUBJECT TO, L F THE PROVISIONS OF
SIGNATURE OF THE BUILDING CODE, ORDINANCE #25 OF WASHINGTON COUNTY,
APPLfCANT AND RELATED LAWS.
VALUATION$ ; X00 THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENC-
ED WITHIN 60 DAYS FROM THE DATE OF ISSUANCE OR IF WORK IS
P.C. ZS PMT. S.� SUSPENDED AT ANY TIME DURING CONSTRUCTION FOR MORE THAN
FEE$ FEE$ 120 DAYS, OR IF ANY WORK IS DONE ON THE SAID BUILDING OR
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION STRUCTURE IN VIOLATION OF ANY COUNTY ORDINANCE OR STATE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LAW RELATING THERETO.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
9UILDING CONSTRUCTION.
A PUBC.IC WORKS DEPT. PERMIT IS REQUIRED FOR ANY MATERIAL
SIGNATURE OF STORAGE OR WORK DONE IN THE ROAD RIGHT OF WAY.
PERMITTEE
r
RESS CHECK VALIDATION cK,', M.o. CASH PERMIT VALIDATION My.�O CASH
PT NO. DATE ri1 RECEIPT NO. �5 /_ /DATE/
111 l�
7 i'�