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BUILDING PERMIT APPLICATION SOF TIGARD DATE 23 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ,ACCOMPANYING PLANS AND SPECIFiCATIJNS, OWNER PH ONE
LOT NO.�____��
OWNERThrrV L111tinQL:lsj JOB ADDRESS ►�•�. I' l.� JLJrL HOME ADDRESS _
ARCHITECT –
.�i. �..�tlIC1 C'3 @('� L?ld {6. ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ❑NEW ❑REMODEL LJADDITION ❑REPAIRI1�� ❑RENEWHL OFIRE DAMAGE ❑DEMOOLITION
RESIDENCE 000M11 ❑EDUCATIONAL QGOV'T ❑RELIGIOUS OPATIO OCARPORT ❑GARAGi ❑STORAGEQSLAB ❑FENCE
U9OND ❑MOVING ❑CONDITIONAL USE ODESIGN REVIEW ❑COUNCIL APPROVcOCJSIGNS
QCCUPANCY —LAND USE ZONE —BLDG.TYPE—__' FIAE ".ONE_3 PIAN CHECK 8Yju# HEAT
[;r,nt:truct_19: 611 12' tadditivn Lc; existiiic ein�ls family due.11if,y,
----- t.cr 'MwwL trl..l Lodw requirements,
- __ - ---- DiumbifiW Pell mit will be required, --
HiQ LIQ 2P 1 2411 r��JOp.OG
oc_C_L2AQ rF1.M8 1.489_ FIGHT -------_NQy$_TQFJIF._S------ AP B—__.- NO.BEDIl49M&� ._—
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit ; 36.C). Q ----- ---
THIS PERMIT 19 ISSUED SUBJECT TO THE REGULATIONS CONTI,INED IN THE BUILDING CODE, ZONING
Plan Check Ia.UJ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 44x0111 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-. RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
:,tate TaA 1,44 LICENSF. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEAPING.
TotalQ` . �
By
--- APPLICANT OR ACiENr — –
Approved •'walden I Receipt No
'-�Pwir,"�
I
k t rY
aDATE INSP. TYPL INSPECTION REMARKS PLUMBING DATE
Contractor
26 ?)� • ILv Permit No. -33
—
wtt
C Hough-in
�w"awi�u�
Fixture
Final ^-
d ��5�_•=,�Y�.1 -1L1�- a� _
HEATING
Contractor
f/ Perm.t No.
Gas or Oil ,
Rough-in
Final
SEWER _
Final �d
DRIVEWAY
Final
Storm Drainage
Main Drulnl Final
Sidewalk —
Curb&Street Final
Approach
BLDGS. DEPT. F114AL TP"MPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
L.amisceping r
Zoning Final
I
4ddress � �/�. �,f�tC� �' Permit No. _ 17
Permit charge
Dwner T� . r ��� .` Connection fee
Paid by
Pype of Building � ,L pate connected
Service Rate Inspection fee
lontractor Paid by Date
Size of connection f '' Assessment Paid
PERMIT TO CONNECT
T
Tigard Sanitary District '/,x
PERMIT :V c' 102059 DATE
PERMIT IS GIVEN TO �-` ��,. t d►-yj ��
r
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT 4L
AT .0i
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID ��'.. ....... .._.......TIGARD SA ITARY DISTRICT
By --
- --------- - - - - --- -- - - - ----
CONNECTION INSPECTED AND APPROVED
Date Superintendent
L _