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BUILDING PERMIT APPLICATION TIGARD DATE .r 19
THE UNDERSIGNED HEREBY APPLIES FO'1 A DERMI T FOR THE WORK HEREIN INDICATED OWNER PHnNF
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. -
OWNER '" ` t Matney -- ADDRESS 17-145 olJ• C,mit BUILDER PHONE _
ENGINEER
BUiLDFRr— ARCHITECT _� _ DESIGNER
STRUCTURE ❑NEW _ GREMODEL. DADDITION ❑REPAIR _DRENEWA. ❑FIRE DAMAGE CIDEMOLlTION
® RESIDENCE ❑COMM ❑EDUCATIONAL DGOV'T 0RELIGIOUS DPATIO ❑CARPORT OGARPGE [:]STORAGE DSI-AB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED (:ISIGNG
OCCUPANCY—LAND USE-ZONE BLDG.TYPE FIRE ZONE_ PLAN CHECK BY_ HEAT,_ _-
_ ilk R�reso!'in�, 9a1r�Q! OA�14:J tua �t11�L� -- --
-- .— --- 1(,30
OCC. LOA) FLOOR LOAD HEIGHT _ NO.STORIES AREA VALUE _
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT 13 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND At-1- APPLICABLE CODES AND ORDINANCES, AND IT IF HEREBY AGREED THAT THE
— — WORK WILI BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIOIJS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
---- — RESTRICTIVE COVENANTS. CONTRACTOR AND SLOB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
176 State — LICENSE. SI'PARATE PERMITS REQUIRED FOR SEWER, PLLEAD1NG AND HEATING.
Total
By I�1 APP—ICANT OR AGEN1
Approved HEcelpt No.
AOOFESS ---- ---- — PH—ONS
—
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough-in
Fixture Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
-T7
Curb&Street Final
Approach
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
Tax Lvt 2 Sl 2 BA 1800 23-10 North Tigardville Addn
Assessnbnt 919.07
Lateral
11-1-61 35.95
& SA the^reaf.ter
Address y,L-' h x'f/ /1� c,Gf
PermitName of of Occupant
—�_ Permit charge
0
- --- Connection fee-__2_g_0_" —�
- - Paid b
y F
- -- ---- - --- ate connected.
Type of Building Inspection
Service Rate- "+
Paid by
Contractor, i
_ - -------____— Aaaebeme�►� , 0 ` _Paid
Size of connection ��y�-- _^ ��
i
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 630 DATEf� �� _ ._
PERMIT IS GIVEN TO
OF
TO CONNECT A -- ' — - -- �–TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
CON-
IS PERMIT MUST Bm POSIYD ON E CTION MADE AND INSPECTION OFCONNECTION PREMISES
BEEN UNTIL
NES INSPECTIONCOM-
PLETED.
PERMIT FEE PAID ;.�..L.1/....1A...........TIGARD SANITARY DISTRICT
By
CONNE(710N INSPECTED AND APPROVED
— - --- - ---- - ftwinten�
Date
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