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15660 SW GREENLEAF COURT �
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ADORESS1�� � �� �� ,�E�C� , Pl-ilMIT NO.— --
PERMIT CHARGE none
G(J%ER °E. X/; �`!tE y` CONNECTION FEE
PAID BY
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TYPE OF BUILDING f DATE CDNNELYED
SERVICE RATE It'SPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION �_+ ASSESSMENT PAID
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lOfli+ E. RElliu!IRCT P(11"O�Nu, IitC,BUILDING DEPARTMENT, TIGARD NO.
P. 0. BOX 11:9 P..UMBING PERMIT �
4 PoEI'tocf J, C"CCS;) °1137 holder of a valid plumbing contractors license is hereby
a ithorized to cause olumbing work as herein, noted to be installed in actor-lance with the lAmbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors. ,
Owne , Address��'lLa1��_�C:L�d'��f' �
NUMBER CF i1o,TAL rcF1MIT NO.'S
TYPE OF PERMIT ITEP4S FEE ON EACH AMOUNT (Office Use Only)
RESIDENTIAL,_ -
Single Famlly-1 bath-each _ _ 25.00 _
Uu lex-Each 1 bath unit 28,01
Additional bathrooms-each 10.00_ p.��G
Moblla Hume Space—each, 15.00
INDIVIDUAL rIXTURE FEES ._
1 to 50 Fixturo"in 1 building-each V_ 3.00_ _
61 to 100 Fixtures in 1 building-each _ 2.J0
101 to 200 Fixtures in 1 building-each - �- 2,00
201 or more Fixtures in t build--each _ 1.50 _
MISCELLANEOUS
Building Sewer-1.st 50 ft. _ r 10.00 _
Sewer-each additional 100 ft. 10.00
Water Service to building -� _ - 5.00
Private Neter Systems-each 100 ftp - 1000
Other (S vcify):
PERMIT For Plurnbing Inspection Phone 63.94191 �+
--,I`K State Plurnbinq Contractor By I1 .
TOTAL RECEIPT NO. Issued By
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1 ` BUILDING PERMIT APPLICATION 11 Y 5�
TIG/�RD DATE 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HFREIN INDICATED BUILDERPHONEr; �� „�—
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNERPHONE
LOT NO..
OWNER •+ "• JOB ADDRESS 5W Gr®c�nlaaf ..
�_. HOME ADDRESS _
ARCHITECT
BUILDER ,iI ENGINEER
AUURE.c S — DESIGNER
STRUCTURE ]NEW ❑REMODEL _— _❑ADDITION ❑REPAIR —❑RENEWAL ❑FIRE DAMAGE ❑DEMOL 1.ION
® RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T-❑RELIGIOUSOPATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
QBOND ❑MOVING []CONDITIONAL USE ODESIGr,' REVIEW ❑COUNCIL APPRGVL7 ❑SIGNS
CCUPANCY LAND USE ZONE ^ __.BLDG.TYPE _FIRE ZONE— PLAN CHECK BY _ HEAT
_ Job #265 Unit 4 uf' Rldq, 21 Thi• is as 2 bod1C�^wm 2" bath tuu rat.ox a _ ,1:t t, +�--
1974 sq.fPt. of l iviny speco with a doublaa garage
Q� `LS2A..Q___F.L,W .4AD__ EIGHT �. 1VQ.1TQ8.1f.3_ �+AkA._----fl14,-@
—BUILDING DEPARTMENT 1:9 ♦ 2�+ cu urs
'F--- SET BACKS FRONT�-- REAR _ LEFT SIDE RIGHT SIDE
Permit t.42.l7tl ..-- ----
T41 PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 1t *00 REGULATIONS AND ALL APFt.•17ABLE CODES AND OR':INANCfS, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDAVCF PATH THi PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CI CES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
� RESTRICIIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax �'1 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 155,56 Sewer Inap 25.00
BY
APPI'CANT Oil AGFNT - -- -
Approved �� Receipt No. {
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