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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIMF - PERMIT NO. '.
DATE: —ILI DATE SS U E 0:
OWNERS NAME '
ADDRESS : —JI
CON'rRACTOR
TEST*. Air L), Water [I , Visual Laboratory E)
RESULT'. Apprnvede� I Disapproved El Pandang D
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(MIPECTOR DATE
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City of Tigard
MSPECTION REOUEST
for
INSPECTION TIME ' PERMIT NO. : - -
DATE: jT.//-2Z ' DAVE ISSUED'--Z-J-.-
OWNERS NAME :
ADDRFSS :
TEST. Ai-- E), water [j Visual D , Laboratory 0
RESULT.* Approved � Ditepwaved U Pending L-]
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ENOTE Attach ± is Ifirnaninl iamt date hsf*tSj
k�l red-*t CITY
7,xO.F MpT IGARD
TIGARD, OREGON 97223 . ,(� .I V_D e
APPLICATION FOR BUILDING PERMIT
New Ccnstruction U Demolish Addition Remodel Move
ZONING DATE ISSUED 3-:)7: 5[ BUILDING PERMIT
BUILDING FEE $ Q� No.
DATE RECEIVRECEIVED-- PLAN CHECK $ A ! 2 - - �-,V-
V=
BY J VALUATION
OTHER J�DJvifTL'$___—_� RECEIPT No.
TOTAL $_ �TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT MAP N CENSUS TRACT _ JOB
Architect or Engineer,
Addresses �� �s', �,s,S �� ....-L s C% It-
Owner
t s Phone_���'a
Owner Z.__, -
P.ddress_\n-%,C, y� \\b-�= p..� —T Phone
Builder
Address Phone
BUILDING USE Single Res. ❑ Multi Res. Comm. U Industrial
OCCUPANCY GROUP _ No. of Stories -- Total Height--__— Area of Lot-------
Type of Construction I II III IV V I•loor Area B_--� 1_ >\12�—^
Set Backs: Front_ Back__ _ L.Side_ - R.Side _
Private Sewer Pipe Size`�� _ Sewer',VL�.n�T,,C:.'t.k9eptic Tank o
Water Service Pipe Size_��y�_ Storm Sewer 9 Ditch ❑ Drywell�
Street and Curb Requirements
Driveway Width _ _._._-__,__--No. of Parking Spaces_
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED !/d/� .S.l✓• /'C�I�G' I% '�F �L i`���: �'
FIELD CHECK BY_— ---,--,DATE_ —
PERMIT APPROVED BJtr•%'�—
It is understood that all wort wjll conform with arplicabte codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the buildilg will
not be occupied until a Certificate' of Occupancy has been issued by the City of
Tigard Building Inspector. _
Slggnnattuur :" nt
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :_ PERMIT NO. : _ r__
i DATE : . "_ � DATE ISSUED:-_1._.J
OWNERS NAME ' -
J/
ADDRESS :
CONTRA C T O
TEST: Air D, Wager ❑ , Visual ❑ , Laboratory [?
I
I RESULT. Approved O , Divapp�oved , Pending L]�
SKETCH:
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I SPECTOR DATE R
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