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BUILDING PERMIT APPLICATION Cor TIGARD DATE � '�'� / rs
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THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HERE IN INDICAT--D BUILDERPHONE—
ORAS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
L.OT NO._ _,—.r
OWNER y, .,t.ot JOB ADDRESS 'J124 aLyldl hQfO i HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER : _ ytl .tirl LldVIAZI13, !UDDRESS 1i.:'t. l' :.I l,, i c.. Lh DESIGNER
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STRUCTURE ❑NEW [.IRI=M_f1DEL ❑ADDITION ❑REPAIR ❑RENEWAL []FIRE DAMAGE ❑DEMOLITION
CJ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAH PORT ❑GARAGE ❑SiTORAGE❑SLAB [-]FENCE
❑BOND ❑MOV ING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY " LAND USE ZONE__ /FSC. BLDG.TYPE �N FIRE ZONE— PLAN CHECK BY_ r�Ll1. HEAT
._.iIc:truct,single faMilg dwelling h detachdd jury+; ,.
-15 UZ Jt VF..kP1IT ;`,' 996 (Lot 1, 916` _511 l ucham 7
5i.wer Permit #'20399 67n.:),00
-
tC�J..4Ai�_—_�_.��.448_1.2HEIGHT 4._•—_NO,3STORIES 1�REA 11• NO 9EDROOMS V11L41E �' � '}
BUILDING DEPARTMENT SET BACKS FRONT 40 REAR 37+ LEFT SIDE 0 RIGHT SIDE �
Permit � L�, .C]A __—�— _ - _-•— ----- •----
tillS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN TH:. BLIILC'ING CODE, ZONING
Plan Check 10.QQ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPE"IFICATIONS AND IN COMPLIANI.i' WITH
Sub-total �, .00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT 1NAIVE
�I RESTRICTIVE COVENANTS. CONTRiACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax ;'., :.�eW LICENSE. SEPARATE PERMITS REGUIRED FOR SEWER, PLUMBING AND HEATING.
Total ltita•HCl SPIL — 1400.00
BY P1r PDL rod# '$100.00 ------ —-- _-- --_ —_---
Q��� APPLICANT OR AGENT
Approved ' Receipt No.
A OOR F 55
DATE INSP. 'TYPE INSPECTION REMARKS PLUMBING DATE
Y�/lam f+G •a — —-- — ------ ---- Contractor
6t -- Permit No.
it --- -- ----- Fixture
Final
`vaJ• }d /wf�/,�%tW� •IEATING
Contractor
`-- Permit No.
Gas or Oil — -
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
— (Rain Drain)Final
Sidewalk
�— -- Curb&Street Final
Approach
BLDG. DEPT. FINAL TI"MPOPARY C Final RTIFICATE OCCUPANCY j
/ /
CERTIFICATE OCC'1PANCY —__
f Landscaping
v Zoning Final