9975 SW JOHNSON STREET MN
9975 SW JOHNSON STREET
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Arldrnss Permit No.
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SEWER PERMIT NI? 12166
ified Sewera—i A,,2nc
Vashington County y C I i'Y OF_ Tic rd_ DATE 5-].2-7
Chi'H R: . . Kenneth Jansen PHONE : 020 2108
._SW l,_!mson , Tigard, Oregon
1 YPE U{= ' '45-rAI_I_A1 10N:
[ j8LJT; DTNCy 3;`N'-t2 ❑F3l T ' GING SEWER AND ,,IDE SEWER
WE OF
❑NCW t-^_1 SINGLE FAMILY ❑ COMM[- RCIAL.
IST . (PRI OR TO 7 I 10 ? l_.J MULT . RES. ❑ INDUSIRIAL
f= IXfURE UNITSDW'.';_LING UNITS _
PERMIT C,)NDI'I ; lj T11F: APPLICANT AGREES TO COMPLY WITH ALL RULES
AND RLGIJLAT I rN`, I': UN T F I ED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, I Cl;R IL) THE PERMIT NUMBER . THIS APPLICATION
i:XIIJ RFS IN i) `4 D TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL
H(c , i ,A T T CSN OCCUR .
s_ 5'5. 00
1*17 4NFCTTON ': n
i 25. 00 ISSUED BY
DATE
"VER PE- N° 121F6
AX IDT SYSTEM
OF `1 —
_ -J ? ��
E ISSUED BY DATE
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CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE June 79 ,s N° G`S 9 9
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVCD IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_
cR ANA UTA.1 i.l.1001E ADDRESS SIJ Johnson :rt. � i iSw-5426
-- hi,LU_R.?Lim
"ULR )Prry f ;ihi+t ENGINlER
H
PA
- FFj C Ia€ W __ DESIGNER
STRUCTURE_ ❑NEW ❑REMODEL I_rr��ADDITION _ _ ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEWIOLITION
RESIDENCE ❑COMM LJEDUCATIUNAL LJGOV'T ❑RFLIGIOUS❑PATIO ❑CAP rORT LIGARAGE ❑STORAGE❑SLAB ❑FENCE
❑BUND ❑MOVING ❑CONrITICNAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑;IGN�
OCCJPAIJCY .JSE ZONE_._ BLDG TYPE FIRE ZONE_ PLAN CHECK BY Jl� HEAT
F.� h" fuundstl,: I wall with vertical .ruolt: ",4" UC next t;: rexicptinw b-Q::er►wit,; wall
OCC, LOAD FLOOR LOAD • •
___ HEIGHT _ NO.Sf_OR_IC: AREA -VALUE
BUILDING DEPARTMENT SET BACKS FRONT gEgq ^'
Permit O V - —_ LEFT SIDE RIGHT SIDE
THIS PI RMIT IS ISSUED SUBJECT TO THE RECULA71ONS CONTAINED IN TH'E B :i
NG
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBYDAG9EED THANG r OF T NTHE
WORK WILL BE DONE IN ACCORDANCE WI7}1 THE PLANS AND SPECIFICATIONS.AND IN COMPLIANCE WITH
Recording ALL APPLICABLE rODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY 911SINESS
State JZr LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER. PLUMBING AND HEATING.
Trial ( / 3' .
APf —AN-1 OR AGENTA
Approval Receipt No./O +
AODNFSS � � '- SHONE• —"
=AMRWM
DATE INSP. TY i PIE INSPECTION REMARKS PLUMBING DATE
76� ?7, Contractor
-Pelfn;t '10.
Hou g h-in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in-----
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage—_
(Rain Drain) Final
Sidewalk
Curb&Street Final
Aaroach
---
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY final
Landscaping
Zoi.ing Final
Tax Lot 2 ST 2 BA 2200 23-10 North Tigardville Addn yy��
Assessment 462 .27
Lateral _67 .06
520. 33
11-1-61 26.47
& SA thereafter
Address J �-j - Le!�A`l/ Permit
Name of Occupant I- Permit charge
Connection fee
Paid by
- Date connected
Type of Building- _ _. ------- -.---...__- Inspe;:tionfee--____----------__........
____.--__----
Service Rate _ -G1 _ Paid by Date,
Contractor Assessment A S3 Paid_.___.
Size of connection
1
Tax Lot 2 SI 2 BA 2200 23-10 Ne Tigar.dvi.11e Acldn
Assessment 462 . 27
Lateral 67 .06
529 . 33
11-1-61 26 .47
& SA thereafter.
Permit No. _ (,
Name of Occupant��/',(` ���.� e.xl Permit charge
Connection fee
--- ----- Paid by— ----- — -
- ----- - - — --- Date connected
Type of Building Inspection fee._
Service Rate..—____ ___�. /L'_ Paid by - --___-Date,
Contr�ictor Assessment =3 Peid
Sire of connection
AP'PT ICATION .EOR 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 eff,,ct or hereinafter enacted and to pay sewer service charges as the same may be im-
posed from time to t�me when due and before such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upon the
property serve-d as stipulated in O. R. S. 224.220.
Connections to the District's system must he made by bonded contractors and, or
bonded and licensed plumbers.
---------Owner
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Oregon