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13 JILDING PERMIT APPLICATION 11TY
TIGARD ZY'2/ _
DATE_-` _. 15__.—
THE UNDERSIGNED HERE'3Y APPLIES FOR APE RMIT FGR THE WOPK HEREIN INDICATED BUILDERPHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPA NYIIJG PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER i. _ _ JOB ADOR_ESSj, �idQQ SLI 11Ft h HOME ADDRLLSS -
ARCHITECT
ENGINEER
BUILDER _ ADDRESS -DISIGNER _
STRUCTURE _ ❑NEW _❑_R_FM_ODEL_ ❑ADDITION ❑REPAIR ❑RENEWAL uFIRE DAMAGE- ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR P,R'T ❑GARAGC ❑Sll RAGE❑SLAB ❑FENCI
❑BOND ❑MOV INC, ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY "'-� LAND USE ZONE.--:'71----.BLDG.TYPE a FIRE ZONE_.'-` PLAN CHECK BY ! � HFAT�
— — 01Istruc.t, a:WitI,o 1 t0 ,rxlut,111,, •it;uie famn.' y d4!sIIi.nu,
OCC LQ 0— FLOO.[3.I_QAD — 1iN_I ---.---. _ ARE _ AOF4344MS "VALUE''+E
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 1�0CJ
--411, - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 4:0 00 REGULATIONS AND ALL APPLICABLE CODES AND ORD!NANCf..S, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS 1N,T SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total 0 0 ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINI ;S
State Tax ., 11(30 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total Z tj()
rA7,
P AVP!-iCANT OR AGENToved ri' Receipt No
l
REMARKS PLUMOING DATE
DATE fIjSP. TYPE INSPECTION
Contractor
0,7 -CT— !ST r L'k, Permit No
--- • Rough-in
Fixture
-5LY11- 2
Final
HEATING
Convac r
Permit N
Gas or Oil
Rough-in
Final
SEWER
Final
11RIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sld.walk
Curb&Street Final
Approach
BLDG. DEPT.FINAL `TEMPORARY CERTIFICATE 045E AMCFinal
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
�cl
2� �:'� � �U
BUILDING PERMIT APPLICATION MY DATE
THE UNDERSIGNED HEREBY APPLIES FOR APEPMiT FOR THE WORK HEREIN INDICATED SUR.DERPHON�
OR SHO),'.'N NC APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. o'wNER PHONrm�Q•._V ��
LAT NO_-.. ._
)INNER
ARCHITECT
EN(.;INEER
'.IJILDER r.DDRESS MSIGNER
<'JE
URE ❑NEW , `. )Fi-. 4DDIiIONREPAIR ORENEWAL ❑FIRED - c �=%10t. -ION
tI;[NCE l J _; .••� T Fl,,C'V'T C1RFLir10US(_1PArio OLAR PUNT R A 6 E
)CCUPANCV V rJ .. PF , v FI E 70NF PLA l.0
_`,�W E R PERMIT "yt.•p--r�J /�� _ ___
)HIeS AREA Aya NQ 8L may► �" f�I�S� O a
--`- ♦Ttl'I QI�I�, - ..i'Y., I =1,1"J T-. �r OEAR "ice .Er T SIC;E V •� G';�I,T _ `�
F'almlt � 1� v t►y
:'L :•s I IS ISSUED SUBJECT TO THE RFGULATIONS CON-AINED IN TN;. B'JM.),NG 'I 'iE :I
Pl,n CheCRZ� �� LATIONS AND ALL APPLICABLE CODES AND ORDINANCES AND IT IS r1lWESY AGREFO TNA' iHk
r. WIL L NC DONE IN ACCORDANCE WITH TME PLANS AND SPECIFICATIONS AND IN COMPLIANCE r`IITF
pub toral APPI II..,BLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT T'.AIVF
- RICTIVE COVFNANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CUPRF.NT CITE b-ISINk5'
ti'd,e Ta+ 1r) cLPAPATE PERMITS RFOUIREO FOR SEWER. Pt UMBING AND HE AT INC.
Total Ilio 0 r
APulovrd Iv1pt rV0
5 D C
PDC
SEWER CONNECTION $.
SEWI R INSPECTION SEWER SURCHARGE
Comments;
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Address 13&)0 S.W. 115th Ave. Permit No. 4704
Permit charge k9S
Owner umbia alIliW Custom �o s ry � Connection fere ....,..._R 425
�( r .n 4-z- is1d by �olumbie Custom Home .._._. _a.,._.
Type of building Res. hate connected
Service rate .00 r month Inspection fee 2
.. .� _ �..�.._.._. _ ,�_.a_. ...._._..�.
Contractor Columbia Cuatom_Homes Paid by same. �u _.w..� Nte
Size of connection 4'1 AsEessment Fail
c? -�