10265 SW KATHERINE STREET-1 10265 SW KATHERINE STREET
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BUILDING PERMIT APPLICATION TIGARD DAT
TME UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONEG�-f_ r�G
OR
AS SHOWN AND APPROVED IN THE ACCO fPANY1N�GyP•L�ANS AND SPECIFICATIONS. OWNER FHONL .. _
0wr4ER .J� Q►�1�`•I+� ;d� JOB ADDHCZ; ��t G3 ,�{/ O{��Q LOTNO.,ll03��,(
ARCHITECT
ENGINEER
BUILDER � ADDRESS ��_ -�—_ DESIGNER 0�/eV- _--
STRUCTURE ❑ NEW ❑ REMODEL ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE �❑ DEMOLITION
C] RESIDENCE ❑ COMM Cl EDUCATIONAL ❑ GOV'T Cl RELIGIOUS ❑ PATIO ❑ CAR PORT% Gi,RAuE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY LA14D USE ZONE — _.BLDG,TYPE NE—FIRE ZGNE r PLAN C PIECK
x M3 a wk—
SEWER PERMIT k
OCC.LOAD FLnnR LOAD �,p►_�� HEIGH NO.STORIES _t AREA� NO.BEDROOMS VALU"
_ BUILDING DEPARTMENTv SET BACKS FRONT fr_ REAR LEFTSIDE IQ RIGHT SIDE
Pur-mit • THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING COLE,ZOr N
�� � � REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HE--EBY AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
t " WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total _— RESTRICT'VE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HA 'E CURRENT CITY BUSINESS
.—� '0n LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATL'G.
�tatE Tex • It.
SDC—
Total r-- __
PDr,# APPLICANT OR AGEN T
By _
Receipt No.
Approved J ADDRESS — —� PHONE
SDC -
PDC - S
SEWER CONNECTION $
SEWER INSPECTION $
St_WER SURCHARGE._
CcmmgOt5:
8W-DING PERM,T APPLICATION TfGARD ranrE
THE UNDERSIGNED HEREPY APPLIES FORA PEPMIT FOR`I HE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPPOVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER P E
LOT NO. � »�l
OWPJCR 5t:+-: �i14'?1 ;,• :�) .� �. JOB ADDRESS • t��i.t1 t .�;1=' �.,
ARCH`ECT
ENGIN :R
BUILDER ► I') ' ADDRESS Alboy? DESIGN
STRUCTURE ❑ NEW _ ❑ REMODELM ADDITION ❑_REPAIR Cl RENEWAL - ❑ FIRE DAMAGE ❑ DEMOLITION
L❑ RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO Cl CARPORT LYGARAGE 0 STORAGE CJ SLAB',] FENCE
OCCUPANCY LAND USE ZONE BLDG.TYPE FIRE ZONE_ w PLAN CHECK BY HEAT--.._
',',tend carport an,, c(.,)rjvc*rt to <T ragT 3. All })%r plans & Cali.
See corrnc-tion sh(- .0
SEWER PERMIT 0
OCC.LOAD FLOOR LOAD '{Tt�OHEIGHT ` NO.STORIES AREA + NO.BEDROOMS VALUE 0 41 l)
BUILDING DEPARTMENT SES BACKS FONT REAR LEFT SIDE RIGHT SIDE
Permit _ ''�� 'al% THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN TOE BUILDING CODE, ZONING
RFGUI_ATIONS AND ALL APPLICABLE CODES AN!) ORDINANCES, AND IT IS HEREBY Af3REED THAT THE
Plan Check '• `{ IV ^.RK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECiFICA TIONS AND IN COMPLIANCE
',ITH ALL APPLICABLE CODES AND ORDINANCE, THE ISSUANCE OF THIS PERMIT DOER NOT WAIVE
Subtotal ; P:.;TRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS i0 HAVE CURRENT CITY BUSINESS
•d.17 LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
Total' t°, 3 5 SDC -
`�"._
By PDrk APPLI NT dR AUNT
'� it 1
r�trrf t ,teceipl !�'a
Approved ADDRESS — PHb?le
DArz INSP. TYPE I_N_VECTION REMARKS PLUMBING
DATE
Contractor
Permit No.
Rough-in
Fixture
Final
HEATING
Contractur
Permit No.
Gas or Oil
Rough in
F mi i
SEWLR
F—Fi—nal
DRIVEWAY
Final
Storm Drainage
Main Drain)Final
Sidewalk
_Curb&Street Final
Approach
BLDG. DEPT.FINAL TEMPORARY EER7i CATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscepitig
Toning Final
P E CT K)N R E �Jl lz
for
Fy
4*�
INSPECTION TIME *.— — PERMIT NO.:
DA-TE: DATE ISSUED:.--Z—J--.
OWNERS NAME : - A.- --- —
ADDRESS : -ZQ2 6f-5-Q- V�A
CONTRACTOR
TEST . Air 0, Water �J , Visucl 0 , Laboratory
RESULT.* Approved Disapproved El Pending Lj-
SKETCH:
INSPECTOR DATE
E:NOTE Attach Supp!,mental test data heretd
i
INSPECTION TIME' _ � PERMIT
DATE: DATE ISSUED :--- LZ
OWNERS NANiE
ADDRESS: ---------._ -_-- '._
CONTRACTOR
TEST ' Air hj , Waterf] , 4isual Q , Labora!ory p
RESULT ' A
pprove(t/l� , Disapproved ❑ , ending LJ
SKET'CH..�--'�
/ft)
INSPECTOR ATE
OTE Attach supplementai test data beret]
1
U f)
Unified Sewerage Agency p
of washinjton County CITY OF DATE
OWNER : h�iYl /a �50 11 _---- -- PHONE : !p
OWNER S ADDRESS = _Z02- &4.1-_.L4
TYPE OF INSTALLATION :
BUILDING SEWER C•] BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY :
❑
NEW X SINGLE FAMILY E] COMMERCIAL
[XEX I r TO 7- 1-- 70 ) ❑ MULT. RES. ❑ INUUSI I? IAL
FIXTURE UP)ITS_ , DWELLING UNITS---k--
ADDRESS
NITS _„ADDRESS OF STRUCTURE :
PERMIT CONDII .TONS : THf_ APPLICANT AGREES TO COMPLY WITH ALL RULES . AND
REGULATIONS OF THE UNIFIED SFWERAGE AGENCY. WHEN CALLING FOR INSPECTION ,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWENTY ( 12o ) DAYS. THE: AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES: _
PERMIT FEE s �`? •
CONNECTION CHARGE d d
SIDE SEWER INSTALLATION -_
ISSUED BY
OTHER
TOTAL
APPLICANT ~�- DATE
*�rr
ADDRESS OF STRUCTURE �� 1Vv
TAX MAP C TAX LOT SYSTEM
�
LOT BLOCK OF L
APPROVED BY DATE I'::SUL0 EtY
t �_ REMARKS _l'Z[M((? ��- t�44 i �(` ---
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