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CITY OP
BUILDING PERMIT APPLICATION
TIGARD DATE. ' et>!ruary 9 ,s 70N2 0669
THE UNDERSIGNFD HEREBY APPLIES FOR APcRMIT FOR THE WORK HEREIN INDICATED OWNER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
±Ibs"1 11111➢ ti�dlE:flU7CIB1I1� 11920 slue Pacific Huy 9UILDERPHONE -
QWNER _ ADC'RESS
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G'RUCTUFIE ❑NEW 0REMODEL _OADDITION ❑REPAIR— ❑RENcWAI. ❑FIRE DAMAGE — ❑DEMOLITIJN
r-1 ,, ❑GARAGE O STORAGE C�SLAB ❑FENCE
1._,1 RESIDENCE []COMM❑ CJEDUCATIONAL CJGOV'T ❑RELIGIOUS�PATIO uCAF PORT_--
�iyNONG ❑MOVING DCONDITIONAL USE ❑DESIGN REVIEW _ []COUNCIL APPROVED OSIGNS
'— —`—� HEAT��
OCCUPANCY— LANA U5E ZONE BLDG.TYPE FIRE ZONE= PLAN CHECK.BY —_---
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� VALUE
HEIGHT NO_STORIES _ 20000
AREA
OCC.LOAD FLOUR LOAD --
REAR LEFT SIi7E RIGHT SIDE
BUILDING DEPARTMENT SET BACKS FRONT __—�---- —
Permit 31.51 00 _
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CC'nE,`Z�ONTNG
Plan Check REGULATIONS AND AL[ APPLICABLE CODES AND ORDINANCES, AND IT l i HEREBY AGREED T..
- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE W'TH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SFPARATE PERMITS REQUIRED FOR SEWER, PLUMS114G AND HEATING
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Total
By APPLICANT OR AGENT
Approved ;1'A Recr,p, No PHS--- �- -
ADDRESS
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Address j "I Permit No.
Name of Occupant r,4_ J-
Permit charge
Connection fee
Paid by
Date connected JI'7 �y
Type of Buflding (�VA!7/0' CCr 1,4 Inspection fee c
y
Service Rate--- Pe;d by Date
Contractor e 1 7 16 S s Assessment_—Paid
Size of connection