11760 SW TIGARD STREET 11750 Sod TIGARD MIMMp�
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CITY OF TIGARD BLDQ. DEPT.
12420 S.W. MAIN ST71�ET
TIGARD, OREGON n"'723
PHONE 639.4111
CONT'NAACTOR:
Pursuant to Section(s) of the Unifor-. Building Code, the
f011f. ruing item(s) require correcting:
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-)ate:- Permit No.
CALL FOR REINSPECTION
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RUILDh.G PERMIT APPLICATION 11 Y TIG ARD DATf__� _/-?_— _-, 19 '1 639„0, 1p
THE UNDERSIGNED HER EB'( APPLiFS FOR APE RMIT FOR THi !'YORK HEREIN INDICATED BUILDERPHONE 9,.:'��'
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PIANS AND SPECIFICATIONS. OWNER PHONE_
LOT NO.
UWNER JOB ADDRESS _- { :-+ d i i 1 /QHOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ❑NEW ❑REMnDEL ®ADD
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--TION (-1 REPAIR ❑RENEY' L []FIRE DAMAGE ❑DEM�-OLITION
❑ RESIDENCE ❑COMM ❑CDUCATIONAL ❑GOV'T L.JRELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND C3 MOV LNG ❑CONDITIONAL. USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY L-3 LAN )USE ZONE La"7�.BLUG.TYPE --" _-FIRE ZONE— PLAN CHFCK II ML jIJ� _� BEAT ^-
l,ons'ruct 2nd story over nxistin4 j reys,, pili plat codra.
iriLludid 4 X 12 sxtsrlor DeC:c
SZCC�L4AD� EIStI�LaQ _.N��� RI - --��A4�1�'l �lQ�9Iz.��OMS. _ VA-LUe
BUILDING DEPARTMENT SET BACKS FRONT a REAR LEFT SIDE RIGHT SIDE
Permit y60.UC' _ _-------- ---- ___-_-- .
THIS PERMIT IS I mum ^UBJECT TO THE EEGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 301 OG REGULATIONS AhID AL L APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
WORK WILL BE DONL .N ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE. N-Trt
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 2.40 LICENSE. SEPARATE PERMITS REQUIRED V704 SFWER, PLUMG;NG AND HEATING.
Total V12. 40
BY -- -
-_ APct IVANI OR AGENT
Approved 11 Rereipt No.
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT M 118 DATE _j,
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PERMIT IS GIVEN TO .,'
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITAnY DISTRICT
AT
THIS PERMIT MUST BE P4TED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PhRMIT FEE PAID ................TIGAItD SANITARY DISTRICT t.
CONNE(MON INSPECTED AND APPROVED
bate Superintendent
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Add resse r �,j',�J �� Permit No.
Permit charge L
1
Owner Connection fee
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Paid by ag
As _
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'type of Building /fie —Y Date connected
aervice Rate ____— Inspection fee—Z-9——
Contractor _ Paid by� --—Date
Size of connectionAssessment Paid
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