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CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE��� N° 0373
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYINC PLANS AND SPECIFICATIONS. OWN,.R PHONE --
OWNER All Usys _^ ADDRESS � BUILDS`1PHONE
ENGINEER
BUILD R CRIluPT I i a PoolsENGINEER
� DESIGNED _
STRUCTURE ❑NEW ❑REMODEL _ ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMA-;E ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAI PONT GGARAGE ❑STORAGE LD SLAB ❑FENCE
❑BOND ❑MOVINli ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGN:
OCCUPANCY LAND USE ZONE— ._—BLDG. TYPE__.._.--FIRE ZCNfc_=PLAN CHECK B_Y. ____ HEAT ——
install 18 x 36 OWietmim, v F1 accardiny to plar's
OCC. LOAD FLOOR LOAD _ HEIGHT NO.STORIES AREA VALUE _
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit :4 — --_ ------——
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPL.ICABLF CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTONS TO HAVE CURRENT CITY BUSINESS
1%State .410 LICENSE SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By
APPLICANT OR AGENT
Approved ------- _ J Ri ce,ht No ------ ---- — - ------
ADDRESS 1igN
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Hough-in
UJ
Z�
T Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
_ao.�jh i n
Final
SEWER OK J9
F-nal
DRIVEWAY
Final
Storm Drairage__
(Rain Drain) Final
Sidewalk
Curb&Street Final
A poach
Fir
BLDG DEPT, FINAI TEMPORARY CERTIFICATE OCCUPANCY TFinal
CERTIFICA-.'E OCCUPANCY
Landscaping
Zoning
oning Final
J
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE: - DATE ISSUED -
OWNERS NAME ; /I&E'er GL�i�yEl -
ADDRESS:/ 11k4m 6) qw&gr-
CONTRACTOR : - - -- -
TEST : Air p, Water }; visna Laboratory C1
RESULT: Apprnved)k� , Disapproved O Pending []
SKETCH:
(1'7
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04VE-C T 0 R DATE
50711: Attach •uDP1ementol tote doto boretoai
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A D D R E S 5 (3 (e Cc C PERMIT N0, S/�
PERMIT CHARGE none
OWNER �,y�i C� . �.c.�a�„� . CONNECTION FEE /)00, 00
PAID BY
TYPC OF BUILDING DATE CONNECTED
M'
SERVICE RATE �, - _ _ _ INSPECTION FEE
CONTRACTOR _ PAID BY _ DATE
SI7_E OF CONNECTION 4� ' ASSESSMENT — PAID ~t.
. 33