13120 SW ASH DRIVE-1 i
BUILDING PERMIT APPLICATION 11T T1GARD DATE.---1--siS!_--7L--, 19_--OF
THE UNDERSIGNED HEREBY APPLiEC FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHON
OR AS SHOWN AN-1APPROVEDIN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE D `�__
LOT NO.— —..
OWNER i • .` ,�t;_ I I JOB ADDRESS' iLill Lia HOME ADDRESS —.—
ARCHITECT'
BRIT161 ENGINEER
BUILDER pp�� ADDRESS
1 t-1 — DESIGNER
�STRUCTURE ❑NEW r-"E14MODEL MAbDITION DREPAIR ❑RENEWAL. [:)FIRE DAMAGE ❑DEfILL,ITION
I_,1 RESIDENCE ❑COMM OEUUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PONT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDI-F IONAL USE 01r7SIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY_— ANL USE ZONE,_I� .l BLDG.TYPE 2N FIRE ZONE—.3 PLAN CHECK BY UtW _ HEAT_ Ui13t:'.
I:;111ait. IU15 room iiiatull b-Athroom in existing &rue roofing 235;; min..
---- — .1
HEIGHT--.___——NQAE.$51QEJ- _._._1.---8B9 210-- -_N-QJ-EM.QOMS YA1—Q.E__ !3'000.
LUILDING DEPARTMENT
� SET BACKS FRONT REAR l FFT SIDE RIGHT SIDE
Permit —� 32.00 — --- _— - — -- --
THIS PERMIT IS 15SUED SUBJFCT TO THE REGULATIONS CONTAINED IN THF BUILDING CODE, ZONING
Plan Check 10.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND I T IS :,Er EBY AGREED THAT THF
WORK WILL. E� DONE IN ACCORDANCE. WITH THE PLANS AND SPECIFIr-A hONS Ai1D IN COMPLIANCE WITH
Sub-total 42,DU ALL APPLIC,ARLE CODES AND OROINAIhCES. THE ISSUANCE OF THIS PERMIT ''DOES NOT WAIVE
-" RESInICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 1.2b LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 43*26
By
APPLICANT OR AGENT
Approved Rereipt No.
1
I
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DATE_ INSP. TYPE INSPECTION REMARKS PLUMBING
DATE
TL-
Contractor
Permit No
I in
Fixture
Final
H E A I I N G
Contractor
Permit No.
Gas or Oil
Rough-in
SEWER
Final
DRIVEWAY
Fina._
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG DEPT FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
•1
Address o S W 0--t- Permit No.
Permit charge
Owner Connection fee
L'1_1&.,4,Paid by �, -L'.'�&
Type of Building _ Date connected
Service Rate Inspection fee
Contractor Paid by 11 �� ' c Date j -Y-(W
Size of connection �/' - Assessment Paid
PERMIT TO CONNECT
Tigard Sanitex%, District
PERMIT N° 1079 PATr• --- -
PFRn1TT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT--- —Ia - - — ---- -- _
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES Ur'TIL CON-
NECTION 1S MADE AND INSPECTION OF CONNECTION HAS REIN COM-
PLETED.
PERMIT FEE PAID $_. . .........................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
te Superintendent
_ ` .._..