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BUILDING PERMIT APPLICATION TIGARD DATE 0 P 19 .-/ ._
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILD E HONE d-
OR AS SHOWN ANO APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
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OWNER 'f .A r C r ///4 'm <. X08 ADDRESS ) ye ARCHITECT' C r _
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/ 2 C r f /3L L . i" /•- DESIGNEF� 44/ :"' / ✓ °'c•
BUILDER . tci • l � f r -e" - . ' ADD ../ %
STRUCTURE 0 NEW '% REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITIO.
❑ RESIDE S CO ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENO
OCCUPANCY E`er LANG USE ZONE L'� BLDG. TYPE -S� FIRE ZONF ""P"-- PLAN CHECK BY "t/ HEAT.
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SEWER PERMIT II ''"---- y ) .•—
OCC LOAD FLOOR LOAD HEIGHT ' NO I . STORIES I AREA �' NO. BEDROOMS VALUE /O�e o0 • BUILDING DEPARTMENT j
SETBACKS FRONT ?..-1/4 ��C RIGHT SIDE
Perm. m.ft 9 •^() THIS PERMIT IS ISSUED SUBJECT TO REGULATIONS CONTAINED IN THE BUILDING CODE. ZOtt!1+ • • 1 •, REGULATIONS AND ALL APPLICABLE C ES AND ORDINANCES. AND IT IS HEREBY AGREED THAT T.:
I PtanCheck �� >Th WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COM.PUAt1C
WITH ALL APPUCABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIv
/ • I Sub-total • Z ? RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINE
1 .> . , UCENSE. SEPARATE PERMITS REQUIRED FOR SEWER. PLUM@It1G AND HEATING.
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Tot • ! / s 6, , Q POCIt APPLICANT OR AGENT
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Receipt No. ADDRESS PTtONE
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SOC 1 _
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SEWER CONNECTION S
SEWER INSPECTION S
SEWER SURCHARGE S
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