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BUILDING PERMIT APPLICATION 10 Y TIGARD DATE_ �/I /
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE IS—
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER Pt�Ir-
LOT NO.
OWNER 1 r6ig L1Ai`keen JOB ADDRESS 1_.'r, �t'I • HOME ADDRESS
ARCHITECT
BUILDER aleck GUthrie ADDRESS ' �„h Awes &L1u. ENGINEER
UESIC+NER _
STRUCTURE ❑NEW ❑RrmnDEL CiADDITION ❑REPAIR ❑RENEWAL ❑F'IREDAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE r]STORAGE❑SLAB ❑FENCE
❑BUND [- MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED [:)SIGNS
OCCUPANCY LAND USE ZONE _ —BLDG.TYPE __FIRE ZONE_ PLAN Cr . X BY�T..-__ ^ HEAT__ _-__-
11f,lLruct adOlt.l.i,gi tic b'Secilt.)olp t. L1 1:ii to sirv,.41L Ietrv.tly dual-'-
40
oal
CCC. LQAD _ __ELQOR LOAb, HEIGHTSZ41315 ,-_AREA N0.BE4R24M __ VALut .,
BUIL.DINu DEPARTMENT SET BACKS FRONT RFAR LEFT SIDE RIGHT SIDE
onPermit ` 2. � _—
J” THIS PFR1dIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check �' l!Q REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11' IS HEREBY AGREED 11; %T THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub•')tal r • Vo ALL APPLICABLE CODES AND ORDINANCES. THF ISSUANCE: OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONT.F'^C(OR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State 1 ax Z58 LICENSE. SFPARATE PERMITS REQUIRED OR SEWER, PLUMBING AND HEATING.
Total t •04
By
2667 APPLICANT OR AGrNI
Approwd —~' -- Receipt No
PI-IONF
® 1
I
DATE INSP. TYPE INSPECTION REMARKS PLUMBING ^� DATE
�'�_-�77 �'�r �yny d i,wToe�/i_ -- Contractor G n
24
�, Parmit No. IO S g46-
Rough-in
Fixture -
F i nal
HEATING
Contractor r
Permit No.
—V Gas or 011
Rough-in
—_— Final
SEWER
Flni+l
DRIVEWAY
Final
Storrs Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT. FINAL TCMPORAI?Y CERTIFICATE OCCUPANCY Final
CERTIFICATE OCLUPANCY
Landscaping
Zoning Final
1
I
�711-
Address / :i�„ ,;<< yC3�E; Cry Permit No. � z>a
Permit charge
Ownor ��tdz _ Connection few
Paid by
Type of building `�_--, ' Date connected YC
Service rate .' Q Zt, Inspection
Contractor - Paid by Date
Size of conr.ectlon `/ Assessment Paid
PERMIT TO CONNECT ,� ,2 ,'T
Tigard unitary District
PERMIT N9 1302 HATE
I'I(I111I1P IS UIVF,N TO
OF
TO CONNECT A Lj
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT f, e-4 y"e._ [�. _'ie 1, e-"-�.THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
7) d U
PERMIT FEE PAID 6......<,....�6.Z. '.....TIGARD SANITARY DISTRICT
-- --- -- - ------- - - - - -
CONNECTION INSPECTED AND APPROVED
Date ----- ----___ _ 5upetintendenc