12205 SW 126TH AVENUE 12205 SW 126TH AVENUE --
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BUILDING PERMIT APPLICATION TIGARD DP TE_ _ - �9_Ij0 _ 3141
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK H!-HEIN INDICATED BUILDER PHONE _620- 561!�
I OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECiFICA TIONS OWNER PHONE "�-� 1 U
---
OWNER �Vid SaundersSaundersJ06ADDRESS 12Laa SI+J 126th
DEIRWOQrj_
ARCHITECT
ENGINEER
BUILDER Westaidta Remour3lprB ADORESS1255i SIJ SummercreSt DESIGNER
STRUCTURE ❑ NEW n REMODEL MDDITION _ ❑ REPAIR_ ❑ RENEWAL_ ❑ FIRE DAMAGE _ 1 DEMOLITION
RESIDENCE ❑ COMM F EDUCATIONAL D GOVT ❑ RELIGIOUS ❑ PATIO ❑ CAF PORT ❑ GARAGE 0 STORAGE 11_SLAB U FENCE
OCCUPANCY R—J LAND USE ZONE —R—�BLDG.TYPE �SN FIRE ZONE-_-3 PLAN CHECK BY HEAT.—__,Q."
Conatruct living room and family room addition_ta existing_ ainclo_Pamil,
duelling. SEE CORRECTION SHEET ATTACHED.
SEWER PERM T N
OCC.LOAD __ _FI.00R LOAD 40 HEIGHT 11 NO.STORIES_1 AREA �JOEJ NO.BEDROOMS VALUEALU t W.-
BUILUINf 'E_0ARTMENT SETBACKS FRONT SF. F PL PI&I4 26 I_EFT SIDE HIGHTSIDE
Permit —_ ►94 aO THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 42. 0--, WORK WILL BE DONE IN ACCORDANCE WITH rHE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDI NCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 126.Gr RESTRICTIVE COVENANTS. CONTRACTOR . �D SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER.PLUMBING AND HEATING.
State Tax 4". 3,36
Total 5129.36 SDC—
PDCB PLICANT OR AGENT - — ---
BY — -- _ P1 _
�;l;H Receipt No.
Approved
ADDRESS PHONE
r
DATE INSP. TYPE INSPECTION REMARKS
u
_ ,. PLUMBING DATE/_� �C 04) Contractor fi
bo � Permit No, -
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�� Rough-in
Fixture
--- Final
HEATING --
_ _ Contractor
-- —_ Permit No. —
- - ---�- Gas or Oil --
Roughin -
Final --
SEWER
---- _ Final
- -- DRIVEWAY
��-- Final
---- Storm Drainage —
(Rain Drainl Final
Sidewalk -
------- Curb 6 Street Final
BLDti. DEPT. FINALTEMPORARY CERTIFICATE OC NCY
CERTIFICATE OCCUPANCY � � _�J � Final —� -- �--—_
1 l_andccaping
Zoning final
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l� _. 8BUILDING PERMIF AI-PLICATION � 04TE 441I �.I ��, E3ul�lc,:. O,c 620-361
THE UNOEHSIGNEO HERI_BY 4r'I''I_IES FOR APEkAAIT FOR THE WUNK HEREININD OWNER P,-+nr/',•� 6ZU' q7
TH AS SHOD".N AND APPRO'0 G IN THE ACCOMPANYING PIANS t,�. 1 SPECIFICATIONS. LCAT NO. � / p_I1tjp0eq
\'JNER (.t.rl f�.��.✓ �( ':.:.JUR.
122o-5-
�— ,IGI NEER
I f�4p T� l�cfJ,Q� C' ��5�.� !�v r-`y'"V�f.�F S+[DESIGNER __
UILD, G v ,qL ❑FIRE-D4'!AGE :�7E
AUU f ION PAP no H f ` r
TRUCTUpE [ NEW.
E C7 RFL ,IOL [_1 `
yr _ . ..
CCUPANI R-7 FIR1
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Rte,Ol �Jwe l vl oQ eo-rad°an S'� �Q•
�)cWCR PERM: - 000
R, 1 p i"4 50P PIAL Of
REAR ZAP E.F ' 5'I)E — r
IS IS'1)Eb fUBJECT TO THE RfGU1.AT1ONS CONTAINED IN (w-- F
;`A^r r!v; tND ALL APPL,ICARLE CODES AND ORDINANCES AND IT 15 HEQ.FY AC, EE 11
Plan 'hr:k /� 4'7 rr " r vL ArN.
� 1A l l NE DONE 1 1 ACCORDANCE \NI?H THE PLANS AND SPECIFICATI J rS L JD % C.
`,u! !Dial r9(p, I9� As'F'11'-r'NLE CODES AND ORDINANCES THE ISSUANCE OF THIS PE',"AIT
:INICIIVI. F'.f7VFNANTS CONTpACTOR AND SUEZ Cl7NJRACTGRS rO HAVE CURRENT CITY EUW-
�• ��-` ..GE CF'.RAIL PLAMITS RFOUIRF0 FOR SEV►Ep PlUM9'NG AND NEArI�NG.
d�N Tai � _ - _
Tula' II iz9, Sld _ `l)4+Sd►/� I Jo�H _
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-
PDC - x _--
SEWt R CONNECTION _ r
SEWI R IN5PE.-CTION
SEWER SURCHARG
Comment.. . �P.c. l ffienJ
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F
Address Permit No. /ny/
Permit charge `"'
e.c-
�i��. Wiz« ��•,
Connection fee
Owner
Paid by
Type of Building_ sa Date connected_ loC-
Service Rate G/ Inspection fee "'rtv
Contractor _ Paid by_ Y Date_
Size of connection ;�'� Assessment Paid
L - ale v
' PERMIT TO CONNECT
Tigard Sanitary District
PERMIT V 1291 DATE
, a
PERMIT IS GIVEN TO
OF
TO CONNECT A _ C
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM.
PLETED.
PERMIT FEE PAID i... -�....'::..E............'tIGARD SANITARY DISTRICT
B "`___
CONNECTION INSPECTED AND APPROVED
Date Superlr&meat