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PERMIT CHARGE none
0UNER CONNECTION FEE
PAID BY
TYPE- OF BUILDING �� � DATE CONNECTED
SERJICE RATE _ 1� INSPECTION FEF _
CONTRACTOR PAID OY DATE
SIZE OF CO';'jECTION _ _ ASSESSMENT PAID
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN ST1'.EET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
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Date: - ._" �9"_ Permit
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Inspector _
CALL FOR REINSPECTION
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BUILDING PERMIT APPLICATION ”OF
TIGARDI DATE---�'
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR fHE WORK HEREIN INDICATED BUILDERPHONF_
OR AS SHOWN ANL-) APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE+.
LOT NO._
NER V'
OWy• JOB ADDRESS HO;.'.,' ADDRESS
— �— -- AFICHITECT —
ENGINEER
ADDRESS DESIGNER
A STRUCTURE _❑NEW _-❑REMODEL ❑F,OpIT10N _ ❑REPAIR ^� []RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
U RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
OBOND ❑MOVING ❑CONDITIONAI USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY ' LAND USE ZONE__ _BLDG TYPE FIRE LONE_- PLAN CHECK BY HEAT_._.___- -
_ kLb My 17-76 ke'-leaue some not iC63,{ SW highland Court.
— ----
F'r.amv Uwsllint� r./attac l.citt -
t onstrur t v.ioy3e fanny dwellinU w/ att-echov 1,,aAaaG4e. (�ledrocio r
ower Permit ) 7468
JCC--,QAQ FLQQIib.Q.Al�._._A
BUILDING DEPARTMENT SET BACKS FRONT 14 REAR 1'" LEFT SIDE " RIGHT SIDE
Permit
_ .
THIS PERMIT I5 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Cheek 16.nn REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WIL L. BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- --- RFSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITV BUSINESS
Statv Tax • E�NSE- u u -
. 5�PARALF f!B�iM4T� REDUtRED FOR SEWER. PLUMBING AND HEATING.
Total � .(; �' onf. ,e} - 1f30.GSA
By Pi
APPLICANT OR AGENT
Approved ;AcAl-den Receipt No
DATE 'INSP. TYPE INWKCTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough-in -f---- �:Z
Fixture
Final
HEATING
Contractor -
-- Permlt No. /
Got or Off —!
Rouph4n
Final
------- -- ----- SEWER
Final �/_i r'-l�J —
--� DRIVEWAY
- Final
Stom Drainage
(Rain Drain)Final
Side- lk
Curb S Street Final
f Approach
19-130.DEPT.FINAL T*MPOIVARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landwapinp
_ Zoning Final —
i,
FORM
• 1
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