11650 SW 90TH AVENUE-1 11.650 SW DOTH AVENUE
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BUILDING PERMIT APPLICATION TIGARD DArE Ju' » 85 5417
THE UNDERSIGNED HE.11:BY APPLIES FOR A PERMIT FOR THE WDRK HEREIN INDICATED SII!i DE^PHONC
OR AS SHOWN AND APPilOVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE___.I§2 "9371
_
OWNER Alan i�Lgr JOB ADDRESS 1165Q 5._y 9 tt LOT N0._
ARCHITECT ^�
BUILDER ''4 ADDRESS ENGINEER
STRUCTURE ❑ NEW---,-[-] REMODEL m ADDITION 1-1 REPAIR Cl RENEWAL [J FIRE DAMAGE _❑ DEMOLITION
11 RESIDENCE D COMM ❑ EDUCATIONAL ❑ GOWT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLS 30 FENCE
OCCUPANCY M -_LAND 111Rc ZONE -A-t-4-5 9LDG.TYPE __.5N__FIRE ZONE---PLAN CHECK BY ETt' H7AT a
_-- c12PMtr q- e„ All pex apgrc)ved Ptaas. - —
SEWER FERMIT# r
OCC.LOA D FLOOR LOAD HEIGHT 116* N0,STORIES I AREA 5_5U NO.BEDROOMS VALUE
�— BUILDING DEPARTMENT -� SET SACKS FRONT _
— Al1..�W LEFT SIDE RIGh T SIDE
-.----
Permit • THIS PERMIT IS ISSUED SUBJEC-i TO THE REGULATIONS CONTAINED IN THE BUILDING O,uDE, ZONING
32.83 REGULATIONS AND ALL APPLICABLE CODES AN') ORDINANCES, AND IT IS HERE6.' fir-NEED',HAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN 'OMPI IApjCE
L'�3•33 WITH ALL APPLICABLE CODES AND ORDINAN,,-ES. THE !SSUANCE OF THIS PERMIT DOCS NO', WAIIE
Subtotal RESTRICTIVE COVENANTS. CCNTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY rIUSINE'..'S
State Tax
2.02 LICENSE.SEPAr ATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
_ f f
SDC — ✓ ,/�
Total 85.35
C PDC# APPLICANT OR AGENT
By ?r,
, a
__---�T[d -- Receipt No. ', .f/.3
Approved ADDRESS
7:' _.
i
KEW
DATE INSP. TIPE IN:;FLCTION REMARKS PLUMBING DA
TE
i�r�� �.--___ Permit No.
Rough-
80 gh-'n
'"g"
F 1,x tu Ete
Final
HEATING
Contractor
Permit No.
Gas or Oil
Haugh Fl
-'u h,
in
Final
Final
tFirul
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewelk
Curb Street Final
A
—1 pproid,
t. ��EITPOkArtY �FliiI6jCTK 0CLUPANC%'
&gLL*. DEPT. -i
o:r-r,T!r1CATK OCCUPANCY
Lond-sr;.-ping
Zoning Final
XWJ[W W
BUILDING RECEIPT
NAME: _ Gr TE:
ACCT. N DESCRIPTION AMOUNT
10-432 Building Permit fees . __y •��
10-431-600 Plumbing Permit Feel
10-431-601 Mechanical permit Fees S _
10-230-501 State Building Tax S
10-433 Plans Che..k Fee
30-443 Sewer Connection (20X) $
30-202 Sewer Connection (00X) $
30-444 Sewer Inspection $
51-448 Street System Dev. Charge (SDC) $
52-A49-610 Parks I System Dew. C�"erge (PDC) $
52-449-620 Parks 11 System Day. Charge (PDC) $
31-450 Storm Drainage System Day. Chrg (SSDC) $
10-230-505 TRFD (95! ) $
10-478 TRFD (5%)
10-13 -506 Washington County Fire M1 (9:;x)
10-478 Washington County Firs N1 (5%) $
10-220 Amart/Wedgewood
TOTAL
(bo/1214P)
THE UNDERSIGNED HEREBY APPLIES FOFI APERNIII FON Iflf: 'WORK HLHLIN INUII.AILU DUILULIt!':IVI4t _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS ANO SPECIFICATIONS. OVMLR•'I'OfIPLRy
LOT NO���.L.�____-_
x,B ADDRESS LL �, '� CfJ �/ L� .— �t•QL (l,�.i�.— �-� �
ENGINEER
AOORE55 1,
STRUCTUgE QNEW ClRESI (IONEL ADOI(IOLJ REPAIR CIRENE'.YAL rjFIRE DAMAGE CJO c:•IOLI
RESILE-"ICC ❑COMMA ❑EDUCATIONAL CJGOV-T ❑RELIGIOUS EIPAT10 ❑CAR PORT GARAGE CJ STORAGE L7-1-I.i GFE
y� — � r --" �N - - PLAfh CHECK BY_��^ HEAT
—_-
CCI P•v;:vim f_"SAND USE ZONE '171OC.TrPE -_—�� __ _
BAR196—OM„—_ BEDROOM _
.SEWER
p F�0013 O —k�1GHT�r —_ NO.STORiU [ A 42 NO.BEDRO N!S-!—PM--Y SFJ r
1 9111LQIN; OEPAgfMENT _, SETBACKS FRONT — REAR '�'k li S►OE`- RIGHTSIuE
741S PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZOA
I% ars Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT
WORT WILL BI: DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CG&lPLIr.NLE N
�S'.1ti•Iotdl 7� ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT W.
PESTRICTIVE COVCAANTS. CONTRACTOR SUB CONTRACTORS TG HAVE CURRENT CIT`! BUSI1
ace Tax I �. L/ 1 LICENSE. SEPARATE PERMITS REOUIREC' FOR SEWER. PLUMBING AND HEATING.
7uta1 I .�' i r 7,S SDC -
r- --- PDC# -
----{ APPLICANT OR AGENT _ (,
I A:protNq! I Receipt No. / / ,r,-(l ") (it-
PHONE
SJ)(' (Storm
SDC -
PDC - ffi_ _ # 0�
SEWER CONNECTION S \. 0 ,� �"�•�I.
SEWER INSPECTION S
SEWER SURCHARGE_ S
Lommen' s :
i
Address Permit No. _ ) 2,5
Name of'Occupant Permit charge
� � ��� , �►
-_ -- Paid by
------ Date connected_ D �- �_•-"' �7
Type of Building. Inspection fee_ ..__
Service Rate— / _— Paid by—_—__ Date
Contractor.--- Assessment166-U-0 __Paid_ �,t,�_
Size of connection