9665 SW JOHNSON STREET 9665 SW JOHNSON STREET
t
n
Address
Name of Occupant ' Pertyit charg
7
2), 4'
17 Paid by
Date connected
Type of Building
Inspection fee
Service Rate-._ vC C)
Paid by Date
Contractor Assessmcnt—
Size of connection
.,, .r+wMotvr wn.w.-...........^+w..wgin,Tr+.r.+.....�rv..-....r......�n,a�,.......�.i..,....,,T..�+.,..ny.rM.v.w.-t..wr+whl+y.«-.v.w+/w7+Ne`VRMM'.../.Mw`.^wa'.«.....•.r.-e..n..Mn1�wyAM•n....rvyn�lrrr�^'y
BUILDING PERMIT APPLICATION 11T TIGARD DATE 12-23 76OF
THE UNDERSIGNED HEREBY APPLIES COR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO. _
OWNER .j'%11 Akin-, JOB ADDRESS )O+' I.r10-1 it HOME ADDRF_'SS _
ARCHITECT
ENGINEER
BI_: ud.'� .�4h1,liOlt ✓$10 • ADDRESS DESIGNER _
STRUCTURE CONEW ❑RFMODELDADGITION OREPAIRORENEWAL _C3_FIR--TTEDAMAGF ODEMOLITION
0 RESIDENCE OCOMM DEOUCATIONAL CQGOV'T DRELIGIOUS OPATIO [JCAR POR r DGA14AGE CJ STORAGE CISLAR OFENCE
❑BOND El MOVING OCONDITIONAL USE ❑DESIGN REVIEW OCOUNCIL APPROVED ❑SIGNS ^
OCCUPANCY_ LANE)USE ZONE- _ BLDG. TYPE FIRE ZON'____ PLAN CHECK BY—____ HEAT--.
_rve akwil1gIi�i "rola .ion d11N:rrnttnueewer billing
Oldg. to be roved a.u. Johnson at.
BUILG"NG DF.PAF-ITMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 5.00 - —--.__—_
— THIS PERMIT IS ISSUFD SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 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
Sub-total AL1 APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS. rONTRACTOR ANI) SUB CONTRACTORS Tn '!AVE CURRENT CITY BUSINESS
State Tax 5.15 LICENSE. SIPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total _ ---'-��_�
By ow
-- A[! 11',TANT OR AGENT -y
Approved Receipt No y.�\1�
AD()141 5-, rHONE