12005 SW ANN STREET-1 i
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12005 SW ANN ,iTREET
Receipt #5655
SEWER PERMIT ti:> 211. 95
Uftinifiet: Sewerage Agency
of 4p!jhington County CITY OF Tim'grd _ _ D A I'E 5/80
OWNER : Hichartd Muralt _ _ PHONE : 639-7191 _
O'WNER ' S .ADDRESS : 12005 SLJ Ann Street
tYPE OF INSTALLATION:
❑ BUILDING ,EWER ❑ BUILDING SEWER AND SIDE SEVER
TYPE- OF 9CCUPANCY:
❑ NEW SINGLE FAMILY ❑ COMMFRCIAL
[X] EXIST. cRi(XMXA"X0XXX9XXSXXX ❑ MUL-i . RES. ❑ INDU51-RIAL
FIXTURE UNITS DWELLItIG UNITS 1
ADDRESS OF STRUCIORE : 12005 SW Ann Street
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER. THIS AFPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 120 ) DAYS. THE: AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATIOrd OCCUR .
FEES:
PERMIT FEE $ 25. 60
CONNECTION CHARGE 680. 00
SIDE SEWER INSTALLATION Penny Liebertz
ISSULD BY
OTHER
TOTAL $ 70.5.00 _
5/5/80
nU T, E APPI_.ICANT DATE
POO
ThIS
SEWER PERMIT No 195
ADDRESS OF STRUCTURE 12005 SW Ann Street
TAX MAP _. 251-30A TAX LOT 111 _ SYSTEM Fanno Creek
LOT �_8L0CK _ OF _
_ DWH 5/5/80 pl 5/5/80
APFROVED BY DATE ISSUED BY _ DAIL
D . U . ' S 1 _ REMARKS Pump & Fill existing spetic tank Per-State CodF,.
Minimum 4" pipe required.
ALSO LERON HEIGHTS SEWER SURCHARGE OF $150.00
BUILDING PERMIT APPLICATION TIGARD DATE__ ____ t __1 ts_��_ 31-97
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR I Hi: WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
L&X LOT NO. _� •"3U�
OWNER Richard U• Mural tJOBADDRESSI7..ODa 561^Ann Street
ARCHITECT
ENGINEER
BUILDER same ADDRESSDESIGNER
STRUCTURE ❑ NEW ❑ REMODEL ®)&DDITION� ❑ REPAIR Ci RENEWAL _D FIRE DAMAGE ❑ DEMOLITION
(RESIDENCE ❑ COMM ❑ EDUCAT,ONAL ❑ GOV'T_❑ RELIGIOUS 0 PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ BLAB❑ FENCE
OCCUPANCY k"'3_LAND USE ZONE `_ 'I'-'BLDG.TYPE aN —FIREZONE 3 -PLANCHECKBY —FJWN HEAT--
Conatruct new elevator deck addition to dwelling, all per plane and_c;orie.
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 40 _HEIGHT 12 NO.STORIES AREA !JO9 NO.BEDROOMS VALL:;k 2,00U.
BUILDING DEPARTMENT SET BACKS FRONT REAR 40 LEFT SIDE RIGHT SIDE
Permit _ �p2G.l�� THIS PERMIT IS ISSUED SUBJECT TO THE. REGULATIONS CONTAINED W THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 1L 00 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES Nor WAIVE
Sub-total 40 UQ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SOWER,PLUMBING AND HEATING.
State Tax .00
SDC—
Total E 30.u 0
PDCM APPLICANT OR AGENT
By _ P 1
Receipt No. '^'I -
Approved x:11:119 ADDRESS —--- PHONE
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
1 �
Contractor
�// / �'��/ �rj[^-• — Permit No.
•/7"' n 1l
Hough-in
----�---
Fixture
Final
HEATING •
Contractor
Permit No.
Gas or Oil .
Hough-in
Final
SEWER
Final
- — — — DRIVEWAY
Final
` Storm Drainage
(Rain Drainj Final
Sidewalk
_ Curb&Street Final
____ Approach —
SLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
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