11190 SW 72ND AVENUE-1 11190 SW 72ND AVENUE
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CITY OF TIGARD 639.4171
DATE
BUILDING PERNAIT TAX MAP '- LUT NO. SUBDIVISION —
OwNE /f- ? ;'I "4JOB ADDRESS , ' J ll` L / —
1� l i to l 1 3 t .L`'`-tet l_.( _ STATE REG.NO. _,EXP.DATE _ -
BUILDER Z� 472
BUILDER'S PHONE —_
ARCHITECT- PHONE _ _—_-.----OTHER
STRUCTURE U NEW ❑ REIAODEI O ADDITION, U REPAIR ❑ MOVE U OTHEROEMOLIilOt+
RESIUENCIE O COMM C) EDUCATION O IND RELIGIOUS O ACCESSORY O GARAGE U OTHER CJ FtNCE
OCCUPANCY LAND USE ZONE .BLDG.T.PE _ FIRE ZANE PUN CHECK BY ►TEAT
,L 4ei1... �J�' o�a 44jk ) R SL 9
SEWER PEP.I,IT 1 _- -- —
HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE
OCC.LOAD _FLOOR LOAO _ �...— ---
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit /.:> _ THIS ,ERM:T IS ISSIIED SUBJECT TO T14E REGULATIONS CONTAINED IN THE NUIL04HO CODE. ZONING
REGlrJ1TIONS AND ALL APPLICABLE CODES AND ORDINANCES.AND IT t3 HEREBY AGREED THAI THE
Plan Chock WORK ,MILL BE DONF IN ACCORDANCE WITH THE PLANS AND SPIMIFICATIONS AND IN COMPLIANCE
WITH ALL Ah'LICABLE CODES AND ORDINANCES, THE MSSUANCE Of THIS PERMIT DOES NOT WAIVE
PI' Fire -- TRESTROCTYVE AX PERMITS.SEPARATE PERMITS REOUIREO f SR SCW R,PLUMBING 1,0111 CONTRACTORS TAND H HAVIII CURRENT
Na 1 ~,r Bty3IN!is
State Tax U
— -- SDC-- ___R __
Total C) APPLICANTOA=;ENT
Prepd. _ -
--- Receipt No. AOORESS
Bal.Due 1
- - Issued By.. —./wprwed BY—
PDC
Y -PDC - —
SEWER CONNECTION 5
SEWER INSPECTION
SEWER SURCHARGE 5 r
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone:639-4175
Type of Inspection ('�"
DateR e - Tima '-' A.M. '.� Q�P.M/�.
Addr ss///�_ 4 /1 Q .- 2zpld Permit #� (yP.` f
Owner - -- Lot # 2 y
Builder --1a
The following Building Code deficiencies are required to be corrected:
Prwanted to —_ C --- -- f I Approved
Disapproved
Do" _ - ------
CALL FOR REINSPECTION
EJ YES 0 NO