16430 SW KING CHARLES AVENUE-1 1.641, SW King Charlem
Kiny City
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CITY OF TIGARD Plumbing Permit
Building F)euartment N0.
Residential ) Commercial ❑r
New Installation ❑ Replace , Addi�ioi; Q Alteration ❑ Dated 61r�"
I_itensed `' )
Flumoer '� �.: :�'►� '_� t`` __ _ Owner "
Address ; , r .a. t" _ ----- Job Address
Phone
Applicant �r L t1.� - d: k�a
CITY BUSINESS LICENSE REQUPRED FOR ALL CONTRAC?ORS AND SUB-CONTRACTORS
ITEM — NO. FEE TOTALT-- ITEM _— � NO. FEE TOTAL,
Fixtures Traps 7.50 _ Sewer:First 100 ft. �_ 30.00
Dishwasher 7.50 —Each Addit.100ft. -- 15.00
Garbage Disposal 7.50 Ejector Pump, 7.50
Water Heater 7.50 Water:First 1 00St. — j 20.00 ( r'
_Backflow Preventer 7.50 _ Each Addit.200 ft. 15.00
�— — Storm_&Rain Drain:First 100 ft. 3000
Each Addit.200 ft. — 15.00 _
_ Mobile Home Space 25.00 —
Other(Specify): _ Rain Drain-Single Fam.Dwelhn _ 15.00 _
EEE
r Comments:
PERMI -
T FEE —_—.- -- -- --.—_
— Issued By:
STATE It% -
__ Receipt No _ _ Applicant
TOTAL �^t J4sig"
c,:
_ For Plumbing Inspection Phone 639-4171
—........e.
BUILDING PERMIT APPLICATION KING CITY PATE— K I U 4, 19
THE UNDERSIGNED HEREBY APPLIES FOR APE qM17 FOR THE WORK HEREIN INDICATED BUILDER PHONE-
OR .4,S SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONZ
LO 1 .110. -`'.a _. r __
OWNER P. JOB ADDRESS 1 ' 'C�9 Sid Klrvrd ! !i4OLq'1HOME ADDRESS
ARCHITECT
�afsf
ENGINEER
BUILDER ADDRESSDESIGNER
STRUCTURE ONEW El RI MODEL C1 ADDITION DREPA13 ORENEWA' []FIRE DAMAGECjDEMOLITION
1 RESIDENCE CICOMM CIEDUCATIONAL 0GOV'T CIRFi-I IOUs EIPATIO L'CAR PORT OGARAGE OSTORASEOSI-AH OFENCE
0130ND OMOVING EICONDITIONAL USE ODESIGN r'--VICW OCOUNCIL APPROVED EISIGNS
.00CUPANCY_n�' LAND USE ZONE ---::�' _.BLDG.TYPE-----FIRE ZONE PLAN CHECK BY----- F4EAr-.,.'-,,=.
LIIie;'%"rUCt bUt wm o otorsiji- ciuset additiun Lu
0olling, A1.1 p4or plans and code.
Jumbing permit required. Apor. by King City 7-9-71i
QCC-.LQA
SUILC NG DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT !9 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN T.--iE BUILDING CODE, ZONINC,
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HFAF:BY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECiFICA-.;,jNS AND IN COMPLIANCE WITH
skit) total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTFIE COVENANTS. CONTRACTOR AND zjUR CONTRACTORS TO HAVE CURREN f Cl f Y BUSINESS
State Tax A. :..!. LICENSi. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total '14,
By APPLICANT OR AGENT
Approved Receipt No
DATE INSP. TYPE INSPECTION REMARKS PLUMBING I DATE
Cantrector ---- -----.
0-rinit No.
&aaa Rough-in
Fixture
------ -- --- --- � Final `----
HEATING
------_-_�-_ ---�— - Contractor -Y-i--
-.._- Permit No. ---- —
- -- -- ---- V- Gat or Oil
---- -- ----------------- •-- � Final
- _.------------- _ SEWER
--- — -------------- --
DRIVEWAY
_. - -_----------_---------- -- Final
`.--.-------4--__._.------ StorN,Dreinarye r
`— -'--------__-`— IRein Dr-.n)Final
Sidewalk
Curb!Y Street Final
Appr
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY V..-.......--__- I
Landscaping
Zoning Final t
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