12400 SW 127TH AVENUE 12400, SW 127TH ,VENUE
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BUILDING PERMIT APPLICATIONCG FY TIGARD DATE " . 19 1
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE�
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. -IINNERPHONF
LOT NO.
OWNER K. SChillin, JOBADDRESS 12400 51j 127t.h A1dt+nL4OMEADDRESS
ARCHITECT
ENGINEER
BUILDER j f•unat. ADDRESS1836 :i P'E 32nd DESIGNER
STRUCTURE ❑NEW ❑Rt'MnDEL ❑ADDITION _ ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ChOV'1 ❑RELIGIOUS❑PATIO CARPORT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND ❑MOVING UCONDITIONAL USE ❑ 'ESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
p OCCUPANCY–— LAND USE ZONE_ 7 BLDG.TYPE= FIRE ZONE___ PLAN CHECK BY_._ HEAT
—
OCCUPANCY----
L I dd.Ltltfn List li'1'iE• F'TUGIi'.:L Ptuu SIB 6l®l.1 par i .J rf. L.UVW Ttit,uif®IflElflt `3
alld l,lO Jr '.0 L,* l 3PH 1-ki lid urea with 891F L:luain., doviuw.
4u7 ° 41GU.0C;
Off• LOAD FL04�L4AIZ.--- LI�ICtNs____-- ---!�.4�Y_2RIE ___._ .._APDL'`_ NO.
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE _RIGHT SIDE.
Permit 3a pQ
t THIS PERMIT 19 ISSUED SUBJECT TO THE RFC?ULATIONS CONTAINEn IN THE BUILDING CODE, 7.0191NG
A! Plan Check ] ,.ICI REGULA','IONS 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
Subtotal ,0n ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOP AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Ta W, LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
TotalBy PI
APPLICANT OR AGFNT
Approved Receipt No
I
bUil uINU F'tHMll AF'1'LILA11UN OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED Bun_DERP►,oNF2 1,54/5
UR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF ICA1 IONS. OWNER PHONE
P , LUT NO
:1M ADL RE!5 _ h '12 /n V ► m�E.AL1C16tG66
—T�=••� IL(i.••� ARCHITECT
r I 2 L ENGINEER
f t)A) ,Tkuf LL)A) ADDRESS L &jUI- e70" _ D.�M10-
UCTURE UNEW ❑REMODEL [AADDITION ❑RLPAIR DRENFWAAL ❑FIRE DAMAGE ❑DEMOLITION
�ESIDFNC ❑COMM ❑EDUCATIONAL ❑GOV"i_ ❑RELtG10USOPAT10 CaCARPORT L.JGARAGE ❑STORAGFCOSLAB [:]FENCE
13SOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
;.CUPANCY 'moi LAND USE ZONE �� ` r BLDG TYPE ,v FIRE ZONE PLAN CHECK BY HEAT�—
p..
IV
ZX-LOAD FLOG LOAD _ HEIGHT -AQ,STOR ES_ AREAI" NO.BFDROOMS _VAL &
_
BUILDING DEPARTMENT SET BACKS FRONT —'---REAR -'-"—"tEFT SIDE '`AMHT SIDE
Permit 2.c9- _ �--
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check ��, REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AC:RFED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb•IOtal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
Stete Taxi Z_� LICENSE. SEPARATE Pf'IMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total C
L�pp,o
.�A PLIC VT OR AO�E1NT
d Recelpl No. fl�!41 L;Zp >
ADDRESS
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FERIdiIT TO CONNECT
39 ,
Tigard Sanitary Distric '
PERMIT No 1442 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT
TO THE SYSTEM OF TIGARD SANITARY DISTRICT T�
AT
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID A.... ................... ..TIGARD SANITARY DISTRICT j
By
CONNECTION INSPECTED AND APPROVED
___Date --_..._._. — SupeMntendent`- -f----;y-`
i
Address / y c , Permit No. /efl
Permit charge _
Owner Connection fee &7-5
Paid by
Type of buildinDate connected
Service rate Inspection fee_ 5" _
Contractor L��J Paid by Date______
Size of connection �� ` _ Assessment
� �no - 6o
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