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BUILDING PERMIT APPLICATION TIGARD DATE-_ -111Y 13 �s_ 1 , 3826`
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF;VATIONS. OWNER PHONE__
LOTNO._ ?9
OWNER J'raui 1'urttlt.�rsx,3 JOBAUDRESS 15U25 5.W• 69th 1'l.
- --- ARCHITECT —____- --
BUILDER C,ertr Curtatrt)ction {'.v. ADDRESS 4630 SIJ CDCha4o IIT. LENGINEER
1"tt,A',DESIGNER - Gertz
STPUCTURE _ 7@ NEW �❑ REMODEL ❑ ADDITION ❑ REPAIR F-1 RENEWAL El FIRE DAMAGE _❑ DEMOLITION
FskRESIDENCE 11 COMM ❑ EDUCATIONAL ❑ ,0'vr LJ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE i_I STORAGE 0 SLAC 7 FENCE
OCCUPANCY _x-3 LAND USE ZONE 12-7 BLDG.TYPE __S.li_—.FIRE ZONE —.._..PLAN CHECK BY ___anL__HEAT v
Construct single fa;;dly dwe.1liap with attached —
�_
See correction SheelL atteclmd.
SEWER PERMIT# 23397 •- �'�<� . �
OCC.LOAD FLOOR LOAn 4Cti HF.IgHT 12 NO.STORIES l AREA 17.35 NO.BEDROOMS 3 VALUE 71.0QU
BUILDING DEPARTMENT SET BACKS FRONT 2 7 REAR 1W' LEFT SIDE 1' RIGHT SIDE 6
-ND1 f- 231.01) -�_ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REG,,.ATIONS AND ALL AFPLICASLE CODES AND ORDINANCES, AI4D IT IS HEREBY AGREED THAT THE
Plan Check 115.51 P(t) WOPK WILL BE DONE IN -%CCORUANCE WITH THE PIANS ANU SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 231.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 9.24 LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
Total 2.4o.24- -- SDC- *.;.j.ofJ
�) PDC# 11 140.00 APPLICANT OFI AOENi
Approved (lt�'tl I Receipt No
/ ' ADDRESS PHONF
9 W -�i III
i 11R -- I
DATE INSP. TYPE INSPECTION REMARKS A II PLO "NO DATE
Contract
— Permit No.
y Rough-in
$- J/ —
� Fixture
9-z -
-- Final
H E A T I N G
3'?0- JGC
Permit No.
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/ oaf ough
-i
I JI
SEWER
—� Final
DRIVEWAY
Final
Storm Drainage
(Rain Drein)Final
Sidewalk
Curb&Street Finat
_ Approach _
BLDG.DEPT.FINAL TEMPORARY CERTIFICATNCY Final
EE OCC A
C
RTIFICATE OCCUPANCY // C/
!_endscaping
Zoning Final
i
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BUILDING PERMIT APPLICATION � g
T1GA,.� DA _i9 8
THE UNDERSIGNED HER�=B'(AFPLI-S FGF1 A PER-IAIT F HEREIN INDICATFCI BUILDER PHONE06-G 346
OR AS SHOWN AND APPROVED IN THF "E<'C717ANYItJG FLANS ANDS, IFICATIJNS, o�r1NEP PHo vE
LOT N0. t' o�
0. E
"JNR TO OK t`l� Y"L& ( 406— JOIA ADDR S
RCHITECT
BUILCFR C_ � NU•EN
I'm-(�' dDRESS _7Gi�,._ _ ESIGNER
STRUCTURE NEW _❑ REMODEL ❑ ADDITION _ :1 REPAIR ❑ REN_EWAL C FIRE DAMAGE ❑ DEMOLITION
RESIDENCE 7 COMM ❑ EDUCATIONAL ❑ GOVT L❑. RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
— - -- -- +- -- - — �—
:rG%,iir ANCY �_3LAND USE ZONE R_-7__BLDG.TYPE'�.N..__FIRE ZONE._--PLAN CHECK BY HEAT �
SEWER PERMIT p — —Y` �-STO
OC,C.LOAD FLUOR LOAD HEIGHT I� NO.STORIES I AREA 17 Or NO.BEDROOMS 3 VALUE= f�pOo
BUILDING DEPARTMENT SET BACKS FRONT R 7 REAR Ir LEFT SICE AWItl RIGHT SIDE _
Permi' 2 —. 0-0
THIS PERMIT IS ISSUED SUBJEC? ;'O THE REGULATIONS CONTAINED IN THE SUILDINj COD2, ZON:Na
I /� , S-0 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check ( K WILL SE DONE IN ACCOPOANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH LL APPLICABLE CODES AND ORDINANCES. THE: ISSUANCF OF TIHIS PERMIT DOES NOT WAIVE
Sub}total ��' SU REST'
I TI'JE COVENANTS. CONTRACTOR AND SUS CON T RACTORS TO HAVE.CURRENT CITY BUSINESS
LICENSE. FPARA"rE PEIiMiTS REQUIRED FOR SEWcR,PLUMBING AND HEATING.
;StitsTax
7
Total
PDC# APPLICANT OR AGENT
By
Receipt Na. _
Approved ADDR753 --- -_____-_- —----_--� PHONE
Lic — S #0 0 .0 Qn,
poc. - S -9— # I® U .�
SEWER CONNECTION S _ _-;�Z✓r?7 �
SEWER INSPECTION rS
SEWER SURCHARGE 5
- 1 s`d 1300
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FU MIA "V 4 d2A
oma- Qla►1, 14 -5 Y /I-f
x /I- F3 �o
1 cl x 2 It• `
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CITY OF TIGARD—12420 S.W.MAIN-o TIGARD,OREGON 97223
RECEIPT
DATE:,�c,L AMOUNT' S
011-
�t + r !r �SLLARS
NAME: 7Ll-l)411 I (6---
ADDRESS: �'('J �L L� o C O s>�Y_a___ HEC
c 4ti. 74 L M.C.: _
#OF
FOR: ACCT. • PERMITS IURCNARIRR AMOUNT_
SEWER BILLINGS 40-364 S
BUSIKSS ''CENSE 05-331 _ __ O O
PLUMBING PERMIT 05-332 S
MECHANIC Al PERMIT 05-332 ---
BUILDING PERMIT 05-333 —_. --------
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV,CHARGE 25-366 —
PARK DEV.CHARGE #1 30-361
PARK DEV.CHARGE #2 30-368 _
ZONING ADJUZ T MENTS 05-362
;fir a,,.
S-0
TOTALS
RECEIVED BY: -
PERMIT NUM/!Rt ASSIGNID:
PlUmbor �A,.moou�nt� Nymba Amount Numb»r _Amount-
a ��
RtCEIPT 0 �� 2