11400 SW 121ST AVENUE J
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11400 SW 121ST AVENUE _
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BUILDING PERMIT APPLICATION Cor TIGARD DATE 19 'r 7 a � '2
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INC GATED 13UILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNERPHONE--
• LOT NO.__
OWNER JOB.ADDRESS HOME ADDRES3
ARCHITECT _
EIUI LDER ENGINEER
—. n ADDRESS _- DESIGNER
ST7UCTURE f-❑NEW 6REMODEL � ❑ADDITION ❑REPAI_R_ ❑RENEWAL ❑F-IRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL GGOV'T ❑RELIGIOUS❑PATIO ❑CAN PORT ❑GARAGE ❑STORAGE❑3LAS `❑FFNCE
❑BOND OMOVING UCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED �CSIGN5
OCCUPANCY---- _LAND USE ZONE_ BLDG.TYPE. FIRE ZONE_ PLAN CHECK BY—,—=---- HEAT_
7 0
OCC.LOAD_ ,-ELQQB—LQAD _ HMti1_ ___NQ.STORIES _ AREA NO.BEDROOMS VALE______ -
BUILDING DEPARTMENT
- �--..,....— SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
THf% PERMIT IS ISSUED SUBJFCT TO THE RFGUI.ATIONS CONTAINC7 IN THE BUILDING CODE, ZONLIG
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND OHDINANCES, AND IT IS HEREBY AGREED THAT 1-HE
- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPI(CABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NCT WAIVE
_.-- RESTRICTIVE COVENANTS. CONTf4IACTOR AND SUB CONTRACTORS TO HAVE CURRENT CIT'( BUSINESS
State Tax LICENSE SEPAHATE PERMITS REOUIREV -OR SEWER, PLUMBING AND FI-ATING.
Total
By
ICAN1 OR ACCENT - -_ -
,Approved Receipt No
ADD Ess -— --- ------ - -
N
DATF INSP. TYPE iNSPtCTION REMARKS PLUMBING DATE
Contractor
Permit No.
Roughin
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough in
Final-
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
Ilk roach
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
CLandscaping
Zoning Final
i
PERMIT TO CONNECT
city of Tigai
Permit N? DATE—
rti ((++
PERMIT IS GIVEN TO '_► ��_ �; ( W .
} "
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL COW
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID f...� .___- CITY OF TIGARD
CONNECTION INSPECTED AND APPROVED I(
Dale •tINltinhnrhht �— _
Adr1rve9_�/� �0 fw�i�/ �� — Permit No. 0
Nerie of OCCCUant Permit charge-_---_-- -_--
Connection fee
Paid by
Date connected
Type of Building Inspection fee _
°,ervice Rate Paid by Dete
Contractor Assessment Paid
Size of connection .� -