11520 SW 121ST AVENUE 11520 SW 121ST AVENUE
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BUILDING PERMIT APPLICATION TIGAAD DATE_
THE UNDERSIGNED HEREBY APPLIES FOR A PFRMI T FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED It:THE ACCO APANYING PLANS AND SPECIFICATIONS, OWNER PHONE
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OWNER Reno Ft11 e t t A JOB ADDRESS 11520 SW 121st LAT NO.
ARCHITECT
ENGINEER
BUILDER
ADDRESS DESIGNER
STRUCTURE ❑ NEW Cl REMODEL rM ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRED AMAGE ❑ DEMULI I ION
❑ RESIDI_NCE Cl COMM O EDUCATIO04AL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE p &LAB❑ FENCE
OCCUPANCY LAND USE ZONE i;" BLDG.TYPE �N__FIRE ZONE_— __P_LAN CHECK BY_ --HEAT—..
'� tton to raxistinl; single family dwelling. Llvin& roam and tint ill;-0�.
SEWER PERMIT#
OCC.LOAD FLOOR LOAD HEIGHT 15 NO.STORIES Z AREA 1159 NO.BEDHCr)MS VALUE
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Psrmit 1.3 3.t)U THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTACTED IN THE BUILDING CODE, ZONING
Plan Check �6 `i0 REGULATIONS AND ALL APPLICABLE 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 ALL APPLICI%B*-E CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 01.50 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 5.',2 LICENSE.SEPARATE PERMITS KEOUIRED FOR SEWER,PLUMBING AND HEATING.
SDC-
Total 7ny,g?
By NT
PDC# APPLICAOR AGE N1
Approved Receipt No. - ------ - - -- - . _
i ADDRESS
-_- - PHONE
_DATE INSP. TYPE INSPECTION PLUMBING
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-- _ LUMBING DATE
Contractor
Permit No. ---- —
4.tClI� Rough-in —
Fixture —
Final
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�_ '"� HEATING
Gt c( Contracts; _ —
/ _ Permit No, j f7�O sY -/-/.7-
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SEWER
_. Final
--_ DRIVEWAY
—_ Final
-- Storm Drainagr
(Rain Drains Final
S idewal k
Curb&Street Final
Approar h
SDG. DEPT.FINAL TEMPORARY CER 'IFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
_ Zoning Final
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BUILDING PERMIT A[ [_:�ATION "FY TIGARD DATE
THE UNDEHSIGNFD HEREBY ANPI-I!:S FOR APERMIT FOR TLiE WORK HEREIN INDICATED BUILDERPFIONF,--
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS A D SPECIFICATIONS. 0%'.NL.F?i4NrJr4F_,6m_!-_Q/7,r
�y /� / LC'r NO L•.r.
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AFtCHI TE:CT --'--
Q ENGINEER
tDC12 / - -- AOUAESS DESIGNER
LICTURE_ (]NEW ADDITION OPEPAIR ❑RENEWAL ❑FIRE DAMAGE
F DENCE ❑COMM DED01-AT11101i (�GOV'T 0REUGI0U1[1PA710 LUCARPORT CIGAPAGE ❑STORAGECISLAS L
PAIJLrR LAND ND US' .' � '�� [TLDG fvPF 4`N. .. —.- QLI�
7777 „1 FIRE LONF�_ PLAN CHECK Bt / ) hE
C.,
:1ER RERMIT
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BUILDING Lr+ +;t!, Eh' FH,JNT +TEAR t.El-' SIDE •atGHl SIDE
RMIT IS I`SLIF.0 SLIB.IECT TO THE RFGULATIONS CON/AINFD t,• '". SL:ILOING C-00F., 2
Check _.—° 'IONS AND At L Arl"LIf-ARr
LE LOOFS A,4O ORDINANCES, AND IS ; T
EPEgr AGREED THAT HE
I L BE DONE IN HCi UFC'r.NCE WI rH THE PLANS AND SPECIFICATIONS AND IN CO�! n
° � ti LI Nvr V;IfH
-total ,_ ,� �^ L ICARLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIJf
- tt iIVE CO1'FNANIS CGNTRACTOR AND SUB CONTRACTORS TO HAVE CUFF6!NT CITY F .j INFF.5
eTAx II S 43. SEPARATE PERMITS REQUIRED FOR SEWER. PLUMBING AND HEATING
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PERMIT TO CONNECT
City of Tigard
Permit N° S 5 6 DATE
PERMIT i5 GIVEN TO _-1Y_�r 1. __rr�_ _
TO CONNECT --�—__-
TO THE SYSTEM OF CITY OF TIGARO
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL COW
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ __CITY OF TIGARD
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CONNECTION INSPECTED AND APPRCVED
Date Superin4 d�Rt
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Address_1,/�� _12/ Permit No,�S�!
Nume of Occupant_________ ______—__ Permit charge 4
Connection fee
-- -- --- ------- --- --- — -- Paid
- -- -- -- Date connected
Type of Building - - Inspection fee
Service Rate--------------- _ Paid by Date
Conti actor Assessment_-_.,- _- Paid
Size of connection
1