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BUILDING PERMIT APPLICATION TIG�ARD DATE 12-5 ?A N° 0132
THE UNDERSIGNED HEREBY APP! IES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS ESHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_--
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QYVNER AUDP�:SS _ BUILDER PHONE
ENGINEEP
buil- ER —___ ARCHITE,:T —_ —_ rr��DESIGNER
STRUCTURE _rr--L--FIJNEW DREMODEL. _ LIADDITIGN 0REPAIR LIRENEWAL L.,JFIREDAMAGE ODEMOLITION
O RESIDENCE L..ICOMM ❑ECIUCATI--ONAI. -0GOV'T ❑RELIGIOUS COP.ATIO OGAR PORT ❑GARAGE ❑STORAGE 0SLAd ❑FENCE
❑BOND ❑MOVING CIC01 TIONAL USE ❑DESIGN REVIEW L.100UNCIL APPROVED ❑SIGNS
QGCUPANCY---.LA.ND U E:!ONE_- BLDG.TYPE —FIRE ZONE-- PLAN CHECK BY_ ___ HEAT—_ _
---------- Paas place — ___-.___•__ —�__^_-- -- _--
OCC. LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE
_
BUILDING SET PACKS FRONT REAR LEFT SIDE RIGHT SIDE
----------- ------ -- -----
Permit
---"'-- THIS PERMIT IS ISSUED SUBJECT 10 THE REGULATIONS CONTAINED IN THE. BUR DING CODE ZONING
Plan Check IIEGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
—'�---'- WORK WILL BE DONE IN ACCOHDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PEI:MIT DOES NOT WAIVE
------ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRAC?OPS TO HAVE CURRENT CITY BUSINESS
S 9,State LICENRE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING ANO HEATING.
1 oral
BY ---
_.—_._.._ APPLICANT OP AGENT
Approved Receipt No.
ADDRFSF, PHONE
DATE INSP. TYPE INSPECTION REMARKS PLUMBING_ � QATF
Z;-
Contractor
NEi -- Permit No. _
ry 7�
Fixture —` T
Final --_~—
_�— HEATING _
Contractor
--- — Permit No.
— Gas or Oil
- —
Rough-in
Final ----
-- ----------
SEWER
------- — Fina I
----.—. _.. _-- DRIVEWAY
— --- Final
Storm Drainage
-•— —__ —_ _ (Rain Drain) Final
— Sidewalk T
Curb&Street Final
—�--- -- A roach_ _--- --
BL+TG. DEPT. FINAL TI:MPORARY CERTIFICATE OCCUPANCv
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
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Address -
--- _ Permit Na,
Name of Occupant__ Permit charge_ 2 O d
---- ----- - � P«id by I
-- -
- -_— Date connected '~ Z/ p�,
Type of Building Cis ^ Inspection fee__ Q C�
Service Rate- R \CiLl r'r l Glc
Paid byDate_��'L��Q
Contractor G Asseesment A
----Paid_..�•.U� _
ti -
Size of connection t� �. )A�� L t
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APPLICATION FOR SEWER SERVICE
The unuersigned agrees, in consideration of the sewer service connection by the
Tigard Sanitary District, to abide by and comply with the ordinances, regulations and rules of the Dist-
rict presently in effect or hereinafter enacted and to pay sewer service chargrs as the same may be im-
posed from time to time when due and before such charges become delinquent.
I fully understand that all unpaid sewer service charges become a lien upor the
property served as stipulated in O. R. S. 224.220.
Connections to the District's system must be made by bonded contractors and,,�or
bonded and licensed plumbers.
Owner _
APPROVED BY
Superintendent
TIGARD SANITARY DISTRICT
8841 S. W. Commercial St.
Tigard, Or.3gon
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