11755 SW 69TH AVENUE min
--- 11755 SW 69TH AVENUE
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BUILDING HERMIT APPLICATION TIGARD r.�TE. marc11 > is ;t4_ 4759
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK.HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PL ANS AND SPECIFICATIONS. OWNER PHONE_.!jA-4q `._._
LOT NO. --
OWNER JOBADDRESS 11755 1��j_L
ARCHITECT
ENGINEER
BUILDER _ _ ADDRESS6310 W 14th Ave* __ DESIGNERSTRUCTURE NEW NEW ❑ REMODEL ❑ ADDITIONA ❑ REPAIR _ ❑ RENEWAL ❑ FIRE DAMAGE rADEMOLITION
[3I RESIDENCE ❑ COMM ❑ EDUCATIONAL Cl GOVT ❑ RELIGIOUS O PATIO 0 CARPORT ❑ ,3ARAGE ❑ STORAGE ❑ SLAB El FENCE
OCCUPANCY _linl—LAND USE ZONE —A=L.BLDG.TYPE _. _ .___FIRE ZONE __PLAN CHECK BYT_ +I HEAT
Dem011shatioii �,n ZxisL:lnp, _Residence �-
- Tai* shall be. Yixvapod b, Filled Wen complete ovaer shall
tloti!y 131ag. 1yjjt• for Final inapectiun.
SEWER PERMIT#
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA _W NO.BEDROOMS VALUE
�BUILDING DEPARTMENT �
SET BACKS FRONT_ REAR LEF SIDE RIGHTSIDE
Permit _ :5.1!t%• THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDIMQ CODE,ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan CheckWORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CC""PLIANCE
WITH ALI. APPLICABLE '_'ODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOl WAIVE
Subtotal RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
.
State lax bu SDC—
Total ----
-' PDC# APPLIFrl'', OR AGENT
Approved "1UJ Recel t No. ADDRESS PHONE
DATE INSP. TYPE INSPECTION 11
REMARKS PLUMBING
DATE
Contrartor
Permit No.
Ro-igh-in
Fixture
Final
HEATING
Contractor
Permit No.
D
A
TE INSP* yp
Gas or Oil
Rough•in
Final
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
BLDG. DEPT. Appronch
TEMPORARY CERTIFICATE OCCUPANCY
,!7ERTIFICATE OCCUPANCY Final
Lan'*'aping
(Rain Drain)Sidewalk
Curb&Sl
ppr...ch
eATE OCf1—
IF no'
L.n'*'.P'ng
Znninq Final
TME UINOERSIGNEO HEREBY APPLIES FOR APERMIT FOH THE WORK HEREIN INDICATE.t) bUit-Outv ,pry
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS ANO SPECIFICATIONS. OK/NEr!ilrorJ _gir
_�svrlEn—. _I ss / j lli! rl --- ---
� ioe ADorE
ARCHITECT -- —
riU11_Oc'7 ENGINEER
ADD!7E;r>', cS t/ OESIGNCR
STRUCTURE _ ❑NEW _vC)RkMnOEL �-JAOO.TION CJRcP.lil �R;HEY/AL �^ _
�/� - -- _ ❑FIRE DAMAGE OE:.IOUTI
l�r"ES10C.1ICE ❑COP/.tit ❑EDUCATIONAL CJGOV-T ❑RELIGI^uSC]%ATIO ❑CARPORT CIGARAGE ❑;;TOaAGE[]SL.la ❑FES
CCCI'P.\G'Y 1',AND USE ZON^c 0 OIDG.TYPE �- T /—�-�—••� --- ---�_i
AN � 4. •FIf1E TONE-!=PLAN,CHECK BY HEAT
— C
(D(9, 657C - Ei ---
�EUE—RP ERf1IT
=-C-Q)5.P _ FLQD3 ..a42
I 91JI1.0'IN, DEPARTMENT
SETBACKS FRONT qp;p
Ct�i � LEFT SIDE RIGHT SIDE
THIS PERMIT IS ISSUED SURJEC.T TO THE REGULATIONS CONTAINED IN THE BUIDIN
L , CODE. TOY
I r �n y eCiC I REGULATIONS AND ALL APPLICABLE COOTS AND ORDINANCES, AND IT IS HEREBY AGRCED 7aAT 1
�-� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANO SPECIF►CAT;ONSD NIN CGhiPLIF,NCE K'
1 b'1titQtd� ALL APPLICABLF. COMES AND ORDINANCES. THE ISSUANCE OF THIS P:,ERMIT DOES NOT WA
i
Tax RESTRICTIVE COVENANTS. CONTRACTOR AND SUB COPITRACTORS TO HAVE "
` :atr I ��' LICENSE. SEPARATE PERMITS REQUIRED FCR SEWER. PLUMBING AND HEATING. "PPT CITY BUSIP'
Total I — SDC
PDC#
---- APPLICANT OR AGENT
Appruvm I Receipt No.
1 L.
anngrKS �110NL
SDC - $
PDC - $
SEUER CONNECTION $
SEWER INSPECTION $
SEWER SURCHARGE $
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