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CITY OF TIGARD
12420 S. W. Main Street
TIGA^D, OREGON 97223
APPLICATION FOR BUILDING PE%4I7'
New Cunstructi.on rz Demolish 11 Addition Remodel lJ MOVE
ZONING _ DATE ISSUED`(Z�- r __ BUILDING PERMIT
DATE RECEIVED BUILDING FEZ $_ _ No.BY
PLAN CHECK $ 7, V3
OTHER $ 7 „o.T,Z.. VALUATION $—. L7 _,
TOTAL $ �j, 5--6 O RECEIPT No. /G,�,�6
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M_ _ MAP N CENSUS TRACT _ JOB A
Architect or Engineer
Address Phone
----.---
Owner
Address -
Phone-
Builder
Address—& 9SS _. s. Iw1_�,9�C/C. /fey✓/ -- ____Phone��� y,3g0
BUILDING USE Single Res. L_`J Multi. Rus. lJ Comm. u Industr'al�-
OCCUPANCY GRUUPi No. of itories Y` _ Total Height_ w - Arna of t,ot
Type of Conatruction I IT III IV V r':.00r Area B l 2
Set Backs: Front_ _ Back_ __ L. 3ide_ R.Side 1
rrivate Sewer Pipe Size_ � � Sewer` Septic Tank C�
Water Service Pipe Size` Storm Sewer LJ Ditch 17 Drywell❑
Street and Curb Requirements
Driveway Width -----------No. of larking Spaces_______-_____
SEPARATE PERMITS REQUIRED FCR SEWER AND PLUMBING
SPECIAL INFORMATION
ADoRESS ASSIGNEDl�^��s���fh�
FIELD CHECK
PERMIT APPROVED BY /eb .
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the lity .if Tigard, Oregon, and that the building will
not be occupied until a Ce_tificate of Occupancy has been issued L, - the City of
Tigard BuildiLj Inspector.
Signature r{ Applicant.
ARM
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