16680 SW QUEEN ANNE AVENUE F-
m
rn
CD
Ln
c
m
rn
z
m
0
H
C
I'T1
16680 SW QUEEN ANNE DRIVE
KING CITY .�
BUILDING PERMIT APPLICATION KING CITY DATE— ''/9/ Ig
THE UNDERSIL33NX HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICA
FD
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PANS AND SPECIFICATIONSOWNDER PHONES 639-310_
�'� ''R. . . .;a;► °U..... 1'1 JOB ADDRESS .16680 SLI Que,.n Anne LOT NO._�:y-tiiny l i�y �n
Drive i n a
ARCHITECT
BUILDER T�G. ADDRESS 306 �' " ENGINEER
--�.3Sy����•— DESIGNER T.Us C.
STRUCTURE CJ NEW ❑ REMODEL 1:1 ADDITION _ ] 4E'PAIR ElRENEWAL ❑ FIRE DAMAGP 13DEMOLITION
O RESIDENCE 11COMM El EDUCATIONAL_❑ GOV'T 11RELIGIOUS ❑ PA"10 ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY I""3 _LAND USE ZONE f�'1 B�DG.7YPE �,t, _—i� - - —�
—FIR.ZONE PLAN CHECK BY rjtrh HEAT Ye"
f.:i)n9�TLI^t ainule family dwelling wfattaLt►ed yarage. i Iiedraanis 2
SEF: CORRECTION aNE.FT ATTACHC(i.
SEWERPERMITN 12�j2b 1Fspua
OCC.LOAD FLOOR LOAD <<O HEIGHT 12 N0.STORIES 1 AREA 1 in,, NO..BEDR_OOMS VAU>tE4 t1*OOI
BUILDING DEPARTMENT SET BACKS FRONT 111 � —
REAR Eill 3LEFT SIDE Ri !IT SIDE I i
Permil t'1. L)11 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDINu CODE, ZONING
Plan CheckaU t�RI REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
• WORK WILL BE DONE IN :ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND 174 COMPLIANCE
Subtotal 271. b(l WITH ALL APPLICABLE CODES AND ORDINANCES. THE :SSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 7, .
LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
Total %27b. 74 - SDC—
By P1 APPLICANT OR AGENT -
Approved dt.!h Receipt No.
---- --- ADDR B8 -- PHONE
DATE INFIR TYPE INSPECTION REMARKS PLUMBING
DATE
ConildCtOr
Permit No, 3
A Rough-in
Fixture
1p Final
CA HEATING
pall Contractor
Permit No,
jz� ;?-0;2- 1, ;Z,9 '?-;'-x
e
Gas or Oil
JRough-in
FFln.1
SEWER
F,nal
b Tlvt
DRIVEWAY
4F inul
Storm Drainago
(Rein Drain)rinal
Sidevw.lk
Curb&Sti not Final
Approach
.. TEMPORARY H—RTIF—ICATr occupx7f-1 I
CERTIFICATEOCCUPANCY Final
I
216
Landscaping
Zoning Final
'J,i.DiNC; PERMIT APPLICATIGN CIT i DATE ' J—. 19� N2
.4 UNDERSIGNED HERERY Af 'I IES FOR APERMIT FOR THE WORK HEREIN INDICATED O ODER"��oNs��'a'oE
;,)q AS SHCWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIE ICA1 IONS. LONER PHONE_11_�__
LOT NO�_.!'Zft-_-
I�IOdDONGSON t o
JOB ADDRESS Il/F9UD JaJ cRUE��A/V _-HOME ADDRESS -- 20 --
ARCHITECT
ENGINEER
ERr4f t1tv ADORc55 La IV 'AlUlt-f__
URE EW ❑REMQDEL ❑ADDII�TION _ ClCI REPAIR ❑RENEWAL ❑FIRE DAMAGE 11 ODEMO1
i�IDENCE ❑COMM ❑EDUCATIONAL OGOV'T ORELIGIOUSDPATIO ❑CARPORT ❑GARAGE ❑STOR/ 3E'rJSLAB ❑
'7RONO D_MOVING OCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED
��j ❑SIGNS
CQPANCY� LAND USE ZONE _._BLDG TYPE�F IRF ZON PLAN CHECK BY .M_U HEAT
0 LL
7 X
----�=u /fin 2 y ,000
(T��1QAQ, FyxnaLOAD _ 4�IS�HL- - _ 4 I9AIF.,S_�� AHED_1l��NO.BEC449_►�1�...__�AL.
BUILDING DEPARTMENT SET BACKS _FRONT O_ �REAR�3 LEFT SIDE S RIGHT SID -
THIS PERMIT IS ISSUED SUBJECT TO THE PFGULATIONS CONTAINED IN THE ellll GING CODE, .
Plan Check ..09 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AP'D IT IS HEREBY AGREED TH
WOPK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANDSPECIf (CATIONS AND IN COMPLIANC
Subtotal ?r ALL APPL'CABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY Rl
�.ibte Tax ? z LICENSE. SEPARATE PERMITS REOUI D FO EWE R, PLUMBING AND HEATING.
Total ^- ;Z76.7#--
By
76,7#--Br APPLICA ,�OR AGENT�fj y��,��y�
Approved --- � Receipt No yw�� '�
HON
ADDPFSS
gnr=
P-IlG-S- #.-
I -
mut c.
. t
Uf'JnifiedSEWER PERMlT � N� zz�zg
Sewerage Agency
of Washington County CITY OF — _ DATE
OWNER
PHONESIS ! , r ('
:
OWNER 'S ADDRESS:
TYPE OF INSTALLATIONt
SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NcW ❑ EXISTING [DS FAMILY ❑ COMMERCIAL
❑ EXIST. (PRIOR TO 7- 1 - 70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS
ADDRESS OF STRUCTURE : _
Permit Conditloos: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of thr location of side sewer laterals. If the :;ewer is not located at
the measurement given, the installer shall prospect three feet in all directions from the distance and depth given.
If not so located, the installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will install a lalval at the location specified by the installer.
FEES:
PEI'.wiIT FEE $
CONNECTION CHARGE
LINE TAP INSTALLATION
OTHER
ISSUED BY
TOTAL 1
APPLICANT V DATE