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��Il SING PERMIT APPI.ICA i-ION " TIGARD OATE�� _ ______. , 19 ___� NA
'.F I� HEREBY APPLILS I ORAPERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE.. —�
4.14C APPROVED IN THE ACCOMPANYING PLANS AND SPFCIF ICA1 IONS OWNER PHONE __
LOT NO —_
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ARCHITECT
O�GI ' l/ cfL_�Y iX -
ENGINEER
c- ADDRESS DESIGNERI1--11 _r-'1
�+E ❑'.F W a ❑RF_ODEL -_ ❑ADOIIION REPAIR ❑R EWAL LJFIRE DAMAGE (]DEMOLITION
---._V ___ — — — 11
;'INCF ❑rr )•mM ❑EDUCATIONAL 0.-,c)V'T DRELIC,I(IUS[3PATIO ❑CARPORT I--.J_ GARAGE OSTORAGEOSLAB ❑FENCE
IND 01,10VING ❑CONDITIIINAI Ust ODLSIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
' »NCY t f.N' USE ZONE_._..---_ __ PLUG TYPE ._—_ _ .. I IRE ZONE.._— PLAN CHECK Y _ _ HEAT _
-.AU F 19S7P_L4AD_____ ._ .._._
N,EIGNT_---.-. .___. RIES_-__._..�?pE --------21Q__HDROOMS YA V_E_2✓_✓_-._.....
PUDDING UErAH'MENT SET BACKS FRO'JT REAR LEF1 SIDE RIGHT SIDE
--- - THIS PERMIT IS ISSI)EI) SUBJECT TO THE REGULATIONS CONTAIVED IN THE BUILhING CODE, ZONING
'Ian Check RI-GULA71ONS AND 4LL APPLICABLE CODES AND ORDINANCES, AND 17 IS HEREBY AGREED THAT THE
- -- ----- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPrCIf ICATIONS AND 14 COMPLIANCE WITH
r Uh total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
/ RESTRICTIVE COVENANTS. CONTRACTOP AND SUB CONTRAUTORS TO HAVE CURRENT CITY BUSINESS
LICENSE. SEPARATE PFRMITS REOUIRED FUR SEWER, PLUMBING AND HEATING.
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` .•),Ir Quad Receipt No
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Ar)Uut 55
/) A/Y
KING-CTPSE•STRUPTUR.AL CHANGE REQUEST
Member G-_°cLtrf'I ,�� J/ � _ Pate
Addross � Phone �.�
TYPE OF CHANGE
(Patio Caver, Room,_ Fence, etc.)
PLAN: DMIENSIONAL AFD MATERIAL DETAILS
Note:
1) Adjacent property owners will be informed of the requested change.
2) If there its an objection, the :')jecti.on, but not the name of the objector, will
be given to the member asking f,)r th.? change.
3; The board of Directors of the CLvir. Association will review the plans and prope:ty
fn% approval or disapproval and compliance with the stated restrictions.
4) A building permit must be obtained from the city for all improvements costing over
'0500-00
Date Notified KCCA Board of Directors
Presi. ;nt
Dote to be Completed (;iApproved� ce -esideat
Final. Inspection Disallowed (Reasons)