8930 SW BURNHAM STREET ti
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8930 SW BURNHAM STREET
BUILDING PERMIT APPLICATION TIGARD DATE_ ,her l _ 19A-L 4671
THE UNDERSIGNED HEREBY APPLIES FuR A PERMIT FUi 1 HE VVORK HEREIN INDIC,",TED O UILDER PHCNE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.__1;i1I_ -
OWNER Randall honest. U8eADDRESS 6930 SW Bum ub-*p�"t. .- - 20U
-' - ARCHITECT
ENGINEER
BUILDER � ADDRESS -_— _ _ DESIGNER
STRUCTURE O NEW ❑_REMODEL 'J ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE QDEMOLI_TION
E;,RESIDENCE`L7 COMM ❑'EDUCATIONAL ❑ 30V_T ❑ RELIGIOUS L7 PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY T _LAND USE ZONE .____BLDG.TYPE _ FIRE ZONE--PLAN CHECK BY HEAT_
lot
-- __ t)�,; litiniL �.x�_ lstg 31�� ► �► _ , --
___ 1 pe r (:.oda >9ttquirejjanfs air -newer <st PrWerty Line
tie )EjC SvtSM RS State ref.m e:nerita. _--
SEWER PERMIT#
OCC.LOAD FLOOR LOAD HEIGHT - NO.STORIES AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT- SET BACKS FRONT _ REAR LEFT SIDE RIGHT SIDE
Permit .Jt1 THIS PERMIT IS ISSUED SUBJECT TU THE REGULATIONS CONTAINED IN THE BUILDING CrjE,ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY ofl,.eED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal _15.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax .61)
SDC-
Total 15.6t1 --- -
PDC# APPLICANT OR AGENT
By LH
-� Receipt No.
Approved ADDRE93 �_ PHONE
i.i'4'
DATE INSP. TYPE INSPECTION REMARKS
PLUMBING DATE
Contractor
No.
F4,
Rough-in
ixture
#F Final
MATING
C
ontractor
Permit No.
Rough-in
Final
;I SEWER
Final
DRIVEWAY
Final
Storm.
Main Drain)Finsi
Sidem 16
Curb&Street F'116)
Approach
131.00. DEpt. FINALTEMPORARYFZC IF1 E CATE——OCCUPANCY
CERTIF'ICATE OCCUPANCY
Lrindivn,ig
Zonino;:inaf
AddressQC73
Permit No.
Name of Occupant Permit charge
Paid by Al
Date connected---
Type of Building Inspection fee
Service Paid by -Date
Contractor Assessment- Paid-- -5-7
Sisi- A connection
APPLICATION FOR SEWER SERVICE
The undersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted and to pay se Wer service charges as the same may be im-
posed from time to time when due and before such charges become delinquent.
1 fully understand that all unpaid sewer service charges become a lien upon the
property served as stipulated in O. R. S. 224.220.
Connections to the District's system mutt be made by bonded contractors and/or
bonded and licensed. slumbers.
Owner -----—_--- -
APPROVED BY
Superintendent _
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregcn
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