81ST AVENUE & SW ROSS STREET i
-- 91-st. & SW Ross St. ---
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CITY OF TIOA
CI'ry0FTMRD 14 PrEII4_
MY T NO. : 169:1.73:�)
COMMUNITY DEVELOPMENT DEPARTMENT 01110
FJ
13125 S.W.Holl Blvd..P.O.Box 23397,Tigarl,Oregon 97223,(503)639-4175
rJATF.':'. I
PM55 (3(?5/ I(:)/ec)
TLJEN(3 D 7311.
S+ d.
,K)EI ADDRESS : XXXXX SW ROSS ST
TAX MAP/1 OT 251. 12CB 200 SUB : I_J : 13K
I.-AND USE :
L 01 S 1:Z E :
WORK GLASS : SITIEW(3114K
OLE-iiE TYPE* : OTHER
(:3.11913A.: YARDS : 300 VALUE :
IMPERV , AREA:
F*1 7 : YES
'-OOPM 1*)r4(.)]'NL[.'7 : YES
F-I�_�"E S
W gia.-y PE rim IT $113 . 5 0
N -
E 7996 aw bailid st PLAN Rlh."ViSW
R TA.p a r,d ar 97223
PHONE (50,311 6134-0805 STATE TAX 1MR 1.H
0 C DEVELOPMENT CE
HAPUS :
N
T
R
A
G
T
0
R I TOTAL . 60
This permit is Issued subject to the regulations contained in Title 14 R E I-I PT N0 .
of the TMC. State o'Oregon PpeciRlty Codes. zoning regulations
and all other applicable codes and ordinances. and It is hereby REQUIRED INSPECTIONS
agreed that the work will be done In accordance with the plans and OTHER*
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive rettrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit wW expire and become null and
void it work Is not started within 180 days,or if work is suspended or
abandoned for a period of 180 days Any time after work has
commenced It shall be We resporuilhility of the permittee to assure
all req"
d inspections are reque0ad and approved
Permittee Signaturd
Issued By
1- FOR INSPECTION 639-4175
SEPARA;'E PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITYOFTIVARD C�Fil6ARD PLAN CHECK APPLICATION
CITYPL" CRECK I
COMMUNffY DEVELOPMENTw�DEPARTMENT oeco _
13125 SW"A Md P.O.Bort 2x.07.ngwd,a+, :1722!Isbl a3G�»s PE1W.I T 0
DA1iE ISSUED
JOB ADn4F,SS:_ S `�S �U4 .yL TAX MAP;LOT ,� u % -/,2 C fj
SUB: LOT: * LAND USE:
VALUATION:_ SETBACKS: FRONT: _ REAR: LEFT: RIGHT:
WORK CLASS: t HEIGHT: TOTAL ARFA:
USE TYPE: FLOOR LOAD: 1ST:
CONSTR TYPE: HEAT TYPE: _ 2ND:
OCCUP GROUP: DWELL/UNITS: 3RD: — -
OCCUP LOAD: NO BEDROOMS: BASEMENT:
NO STORIES: _ NO BATHS: GARAGE:
IMP SURFACE: -----�-
APPRO_VALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: REISSUE OF: LIST SUBCONTRACTORS:
ENGINEERING: LAST REISSUE:._______ BUS TAR: --
FIFE DEPT.: FLOOD PLAIN/ CALCULATIONS: —
OT VR: SEN LND.: TRUSS DETAILS:
PARKING PLAN: _
LANDSCAPE PLAN: `-
PLAN CHECK BY• / OTHFF
COMMENTS: � •49�c�. Ci/1_,;E.1,�
ACCT DESCRIPTION k+)UNT
OWNER 10--432 Building Permit Fees =
"2-431-600 Plumbing Permit Fees t
ADDRES : f&r�fcl j' 10-431--601 Mechanical Permit Fees
'11090, 1 9')12 3 10-230-501 State Building Tax (5X)
_ 10-433 Plans Checl: Fee
PHONE: 30-443 Sewer Connection-- -
30-202
CONTRACTOR 30-444 Sever Inspection =`
NAHE: _ " Gt .51-448 Street System Dev. Charge (SDC)
ADDRESS: 52-449-610
-_ 52:-449-620 Parke System Dev. Charge (PDC) S
31--450 Storm Drainage Syst Dev Chrg(SSDC) t
PHONE: --'
10-230-505 TRFD (95X)
10-435 TRFD (5%)
ARCH/ENGINEER 10-230-506 Washington County Fire /1 (95x) = T
NAME: 10-435 Washington County Fire 01 (5%)
ADDRESS: ~' 10-220 Amart/Wedgewood
VHONE- —�- -''- TOTAL s--
PREPAID
REC
BALANCE DUE
APPLICANT SIGNATURE --_�—
,leelv^ri RV: Date Received: