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BUILDING PERMIT APPLICATION C� TIARD DATE_____- 19_
THE UNDERSIGNED HEREBY APPLIES FOR APERIAIT FOR THE WORK HEREIN INDICATED BUILDLRPHONE --
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO. —_
OWNCR _ JOB ADDRESS _ HOME ADDRESS _
ARCHITECT
ENGINFER
BUILDER _ ADDRESS DESIGNFR
STRUCTURE ❑NEW ❑RfMODEL ❑ADDITION ❑REPAIR []RENEWAL _ ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS[]PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BUND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS -
OCCUPANCY USF ZONE__ , _BLDG.TYPE_ ____FIRE ZONE PLAN CHECK BY.—__ - HEAT. __
area to Existing single family ow—ullirl•
J1 pcat plvnM.
OCC.JLOAD _—F1S?9A LOADi ----HEJ.UtT_._ _ NQ U-U-�S .. ARES r �_ N4 OROOMS ___yLFIL41€_.__'...'_
._ BUILDING DEPARTMENT SET BACKS FRONT REAR J� LEFT SIDE I` RIGHT SIDE I.
Permit
THIS PERMIT IS ISSUED SUPJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE ZONING
Plan Check REGULATIONS AND ALL AP01.ICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN A-CORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
�- - - RESTRICTIVE COVENANTS CONTRACTOR AND SUR CONTRACTOES TO HAVE. CUHNENT CITY BUSINFSS
State Tax LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLLIMRING AND HEATING.
Total
By
------- APPLICANT CIH AC.Ff4T
Approved L:` C1W TJ iirvrilit No
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DATE INI%P. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
— �k=' Nough•in
TI--
1,
-- � --
�- �� O - 'N. L -' .(IyL L.]L]t l uN - 411 A--Z T`-' --- -- —,._
1' Fixture
Final
.—. —_ —�---____ __ _• HEATING
Contractor
Permit No.
Gas Or Oil
-- - -- Rough in
i — Final
_ - --. SEWER -
Final
—� — DRIVEWAY
Final
Stom Drainage
(Rain brain) Final �
_ Sidewalk
Curb AI Sfreef FInNI --_- —.—
Approach oach
BLDG. DEPT. FINAL TtMPORARY CERTIFICA'T'E OCCUPANCY Final
CERTIF [ICK� OCCUPANCY
Landscaping
Zoning Final
Address /3,r,Yc �H'. N3/y P.,"41t- Permit No.
Name of Occupant00ti) JTl N 1 Permit charge__
_ Connection fee
----- ----- .. - Paid by___
- Date connected
Type of Building-_� 1 S�pENt C'
_ Inspection fee.
Service RatePa
'{ irdby
Contractor .� C�/r/��r .tr Assessment Paid
Size of connecHotl
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PERMIT TO CONNECT
Tigard 3"anitary District
PERMIT N° 789 DATE
PERMIT IS GIVEN TO 171/1 orOF
Z.
/t
It Voo,7/
TO CONNECT
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT 7
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONDIECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID .. ................. .........TiGARn 9ANITA"0IWFf"—
('ONNFif,'TION INfiPIECTEU .'1NI1 APi'R(lPFU
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