12635 SW 111TH DRIVE 1263.5 SW 111TH DRIVE
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ADDRESS_ jjy•3S PERMIT NO.
PERMIT CHARGE none
0i�;,'. r CONNECTION FEE ),
_. PAID UY
TYPE OF BUILDING _ ��,/, DATE CONNECTED
SERVICE PATE �� _ INSPECTION FEE
CONTRACTOR P,'% ID BY DATE
SIZE OF CONNECTION _`_ ASSESSMENT PAID
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
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C%� `� � .- J. /---�Q-►.�/� Com_--1��
_cC1 "�� yC.-Gt -_ '��✓ 4Z mit
'ate:_1C�/�'�_ Permit No.�_
Inspector
CALL FOR REINSPECTION
7 W W T q
BUILDING PERMIT APPLICATION COF
IT `TIGARD DATE lob 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK iiEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPJ12NEr
LOT NO. 1J.,1L1:rlr c,..
r-n t Pan JOB ADDRESS12L'LCL, liLl J,ll til r'J.al 1:6 HOME ADDRESS
ARCHITECT
ENGINEER
13JILDER r PrP t'.[4T ADDRESS126:5ra 5th 2088 L30110 R011d QESIGNCR -
STRUCTURE ANEW ❑RI MODEL ❑ADDITION ❑REPAIR []RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE [:]COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB []FENCE
❑BOND []MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW _ ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY..:.=__.�_LANO USE ZONE 1`nBLDG.TYPE 5!`3 FIRE ZONE.-j PLAN CHECK BY E TLI _ HEAT �_____
_ r'ryrr>64_rjuirk,Jm family dwani ci w/utthyilrr S li�rdraom
IiijAIRF4 AEibur to l,n .j" ID min,
!W,e Ivr NermiA :+1744L _
Q4C_l Q91L___—F144.LLOAD 40 HEIGHT �� ��I gy$jQRIES �' Si172A _R_Q_BEDRQQMS 3 VA4F9y .1
BUILDING DEPARTMENT SET BACKS FRONT 3=� REAR 40 l E I T SIDF A RIGHT SIDE la
Permit 1184a OQ
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, CONING
Plan Check 92000 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
--- WORK WILL BE DONE IN ACCORDANCE WITH THE Pt AMR AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total DoALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND 5118 CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State TalwLICENSE. SEPARAT
l 7,31 ,PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 5283,36 1
By _ pl APPLICANT OR AOENI
Approved t" .I,IRIdpn Receipt No
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
101 ? _ _ srl Permit No. r
Rough-in
Fixture
Final -- - -- --
HEATING
g ���_r P�,�t,v v, Contractor
Permit No.
Gas or Oil
HoughAn
Final ___-_ -----
SEWER
Final
DRIVEWAY
Final
Stora. Drainage
(Rain Drain)Final.
SideweIk
Curb A Street Final
Approach
BLDG. DEPT.FINAL TtMPORARY CERTIFICATE OCCUPANCY _
CERTIr iC ATE OCCUPANCY Final
i_andscaping
Zoning Final
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAi!d STREET
TIGARD, OREGON 9i223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
_1-?L 4 l6T. V�P 7
)ate: Perrnd No.
Inspector
CALL FOR REINSPECTION