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CITY OP ✓G '`'/" N° 0076
BUILDING PERMIT APPLICATION TIGARD DATE— __ 19
THE Im,DERSIGNED HERERY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE--------
OWNER
HONE -------OWNER _ —_ ADDRESS — „_ BUILDER PHONE
^} ENGINEER
BUILDERc '~` (I.,L ARCHITECT — —� DESIGNER
STRUCTURE NEW _AEMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE — ❑DEMOLITION
❑ RESIO-NCE [:]COMM-- ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GA9AGE ❑STORAGE❑SLAB [:]FENCE1 BOND UMOVING ❑CONr ,TIONAL USE ❑DESIGN REVIENr ❑COUNCIL APPROVED ❑SIGNS
QCCUPANCY--_LAND.USE`r0N4— _ —.BLD .TYPE __FIRE ZONE_ PLAN CHECK BY_ HEAT
QCC.LOAD FLOOR LOAD — HEIGHT NO.STORIES AREA VALUE _
BUILDING EJAPARTMENT SF 1 BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILLING CODE, ZONINts
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORCINANCFS, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCOPDANCE WITH THE a SANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording AL1. APPUCARLE CODES AND ORDINANCES. THE ISSUAN1,F OF THIS PER,'AIT DOES NOT WAIV[
T— RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVF CUFIHENT CITY BUSINESS
1%State �4 G LICENSE. SEPARATE PERMITS nFOUIRED FOR SEWER. PI-UMBING AND HEATING.
Total
By -- — — --- --
__ APPLICANT OR AGENT
Approved Receipt No
-- _ ADDRE'S5 --—>f HONE -----—--
4
i
DA-C INSP. TYPE INSPECTION RF.MA!IKS PLUMBING DATE
— - _ Contractor
-- --_ --_--�_ — P*rmit No.
Rough•in
----- — — Fixture
---- —� Final
HEATING
Conh actor
— ----.—.—_ ---__ Permit No.
__-------__—_-- Gas or Oil
Rough-in '
--- -----_- Final —
_^_... -- - - — — SEWER
-- --e _ Final _
---• DRIVEWAY
-- — - Final
Storm Draina e
(Rail Drair) Final
--- �— Sidewalk
—. Curb &Street Final —
--
Approach _
SLOG.DEPT, FINAL, F-CERTIFICATE
TEMPORARY CER n9CATE OCCUPANCY
OCCUPANCY Final
Landscaping
Zoning Final