12345 SW 128TH AVENUE ell
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CITYOF TIVARD MASTER PERMIT
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COMMUt rrY DEVELOPMENT DEPARTMENT �.��'"' =BERM I T #. . . . . . . . MGT91.-0181
13125 SW FWD i vd. P.O.Box 23307,rVud,0i egos 07223(603)630.4176
L �__ DATE I SSIJE-D: 1 .1/�1/91
S I Ti= AD1)RI-SS. . . : 1,.345 SW 1;RBTH AV PARCEL.
SUBDIVISION. . . . : BELLWOOD 3 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOl.. . . . . . . . . . . . . : 131
BUILDING
REISSUE: DWELL_I NG UN I TS: 1 BASEMENT. . . . . . . . :0 s f
CLASS OF WORK. :AUD BEDRMS: 1 BATHS:O GARAGE. . . . . . . . . . :0 sf
TYPE nF USE. . . :SP FLC3R AREAS------------ REQUIRED SET1:4Mi.:KS--
TYPE OF CONST. :5N F IFS-r. . . . :260 5 fLF -T. . : 15 ft R I GHT. :0 ft
OCCUPAACY GRP. :R3 SECOND 312 ,f FRONT. :0 ft REAR. . .40 ft
S I OR I E5. . . . . . . :2 THIRD. . . . :0 s f REOU I FRED----_---.--_._-----__
E 'Y
HEIGHT 5 ft TOTAL. — 57-:? f SMOI ..
FLOOR LOAD. . . . :40 psf VALUE. . . . . $.- 26312 PARKING SPACES. . .-0
Remarks : 572: SD FT ADDITION 2 STORIES
PLUMBING
51NiiS. . . . . . . . . :0 FLOOR DRAINS. . . . t@ BACrJ- LG;I PREVNTRS. . :0
LAVA-rOR'.ES. . . . . : 1 WATER HEATERS. . . -0 TRAPS. . . . . . . . . . . . . . :0
TUE/SHO IERS. . . . :0 LAUNDRY TRAYS. . . :0 CATCH BASING. . . . . . . :iii
WATER L JSE-rS. . :0 SEWER LINE (ft ) . :O GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :17, WATER LINE:. (ft ) . -0 OTHER FIX'rURES. . . . . :i7..i
GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :O
WASHING MACH. . . :0 SF RAIN DRAINS. . :0
MECHANICAL -----_-.._.__.__ FEES - -
FUEL TYF'F_5---__._____.._. UNIT HTRS. . :0 type amol.tnt by date rerpt
/6AS/ / / VENTS . . . . . :3 BPRT $ 179. 50 PLL 1 1/c?."-j1 21
MAX INPUT-0 BTU VI`:Nl' FANS. . :0 BF=,LC $ 116. 68 .JI_H 11/16/91 2198.:''6
F'URN ( 100t" . . :0 HOODS. . . . . . :0 F45FIC f 8. 96 PLL 11/21/91 21
FURN > =100K . . :0 WOODF31"OVE( :0 MPRT s 25. 00 PLL 1 1/2'1/91 21
FL DOR FORIV. . . . :0 CLO DRYERS. : 0 MGl_C 6. PL-1- 1 1/21/91 c'r
BOIL/CMP ( 314P-0 OTl-1E R UN I T5:0 M5PC 11 1. 25 PLL 11/2,1/91 1
GAS:, OUTLE 7 5:0 PPRT $ 25. 021 FALL 11/21/91 c'1
Owner: -__.__ ._.__..._____.__________...__._._.._._._..___ ._._.._. P 5 P C $ 1. 25 PLL 11/2'1/91 .'.l
ROBERT PAVLUKOV I CH
12345 SW 1,28TH AVE
T I BARD OR 972L3
Phone +: : ':39-16O(Zi
Contrac•tcrr: -----.---_------_------__---._--_
MICHAEL AND CO.
15575 SW 74TH AVE
TIGARD OR 971'-.24
Phone #:
i`- Reg #. . : 45808 _._.__..--.-----..---_------___....._.______.__
:363. 91 TOTAL
h This permit is issued subject to the regulations contained in the - - - --- HEUUI RED INSPE:C'rIUNS -- -- --
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/foLtnd Insp Rain drain Insp
applicable laws. All work will be done in accordance with approved Plm/1-tnds1ah Insp Mer..harical Final
plans. This permit will expire if work is not started within 180 PL-M/Underfloor P1Ltmb Final
J days of issuance, or if work is suspended for more than 180 days. Mechanical Insp Bt_t i l d i ng Final.
Plumb Top Ol.tt Ero,aion C,)ntrol
Permi ;:tee Siynatf.tre : Framing Insp
Insulation Insp
I s s i-ted B y : ___..__..._._...._._..__-- _ .._._.__.,-.... .__.. 13 y p Board Insp
Call for inspection — 639--4175
t�lawd. PLNCK/RECT CITE' nF TIGARDPO Flox 23397 �
COM1iM11UN1'il' I)I't'I:LOI'MGN'!'I)I:1'AI2'I'PIEti'I' Tiigard,Orcgon97M PERMIT 0/9/
(503)634-4171 DATE ISSUED
`_)OB ADDRESS: �,[�J �f SJ 5��) t Z—c _ TAX MAP/LOT 112,,0
SUB: //ciao # .3 LOT: 131 LAND USE:
VAL.UAl I ON:
OWNEC SPECIAL NOTES
NAME: ( 1 � (��f v�u��o�;r_c�t REISSUE OF:
ADDRESS: i LAST REISSUE:
U — 223 FLOOD PLAIN/
PHONE: .3S - ��oC3z' SENSITIVE LAND:
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CONTRACTOR / APPROVALS REQUIRED
NAME: ^4; PLANNING:
ADDRESS: I 7.v .,> ENGINEERING:
G )c�1� FIRE DEPT:
PHONE: Co `- ( 7 S OTHER: tp0 /
CONTR. BOARD #:� (v Co S S�7 EXP DATE!
ITEMS REQUIRED
SUBCONIRACTORS: _PLUMB: . w��ct�rt4 1 CUe LIST/SUBCONTRACTORS:
MECH: _��-- - �Z c BUS TAX:
ARCH ENGINEER ' CALCULATIONS:
NAME: SCC�Lf— TRUSS .DETAILS:
ADDRESS: 4 01-HER:
PHONE:
CL
N PROPOSED BLDG. USE:
COMMENTS:
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APPLICANT SIGNATURE
Received By: �. _ Date Received: // — /i j
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. SAL. DUE
10-432 00 Building Permit Fees -� '��,�o /`"1-°_$v
10-431 00 Plumbing Permit Fees _ ? � ° _ 2�•�0
10-431 01 Mechanical Permit Fees _ ��,`" Z��•v
10-230 01 State Building Tax (5%)
Building _ 91- *"
Plumbing z;
Mechanical
0
10-433 00 Plans Check Fee •9.3 G :ZS
Building _ v 6-
Plumbing _
Mechanical
10-230 06 Fire
30--202 00 Sewer Connection
. -444 00 Sewer Inspection
25--448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PUC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
- 24-445-02 Water Quantity (Fee in lieu of)
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TOTAL d6d YI 2. 11. Z3
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nm/3581P.W11F
e F Permit No:
Q r •, Address: _-
= Issued by: __ Date:
L...... FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERT`! OWNERS
ABOUT CONSTRUCTION RESPONSWILITIES
Note: Oregon Law, URS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Licensed Architect
and Enginaer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2E:
1. � I own, reside in, or will reside in the completed structure.
2. A. = My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. � I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Constrcction Contractors Board. If I change my mind and do hire a general
contractor, I will contract with a contractor who is registered with the
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information Is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INSPECTION NOTICE
City :>f Tigard Building Department
13125 Sp Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 539-41.71
Inspections
Footing Plbg. Underalab Hoch. R,ugh-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL::�
Post/Beam 8truct. Sart. Sewer Framing -eldg. J
Post/Beam Rech. P-in Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. ed. r -Nech.
^
Date Requested: -eq
--.� Time: _-AM PH
Address: ✓L Permit
Builder:
TI4E FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Dates
APPROVED DI8ATPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SK Hall Blvd. Tigard, Oregon 97223
Inspection, Line (Rec-O-Phone): 639-4175 Business Phone: 639 4171
Inspection:Y
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwl;:
Pound. Plbg. Top Out Cas Line FINAL:
Poet/Beam , .:ruct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb. 1
Plbg. Underfloor. Water. Line Gyp. Bd. -Mech.
Date Requestedt__ An —� Times AH/� G /PH
Address: J `s permit #:
builder;
s
THE FOLLOWING CORRECTIONS ARE REQUIREDs
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Inspect/or: ./ Dater
�( APPROVED DIAAPPROVED -� APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41.71
Inspections _ —
Footing Plbg. Underslab Mech. Rough-in Appr./Sdwlk
Found. Plbg. Top Out Sas Line FINAL:
Poet/Ream Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water LineCyp. Bd. -Hoch.
Date Requested:` _-_ Time: L AN 6"� PH
Address: 1� I L�tt- Permit is 1•,^`/ar 'P��I'_
builder: YJ (l�f J2- r (�L _ nz` �(�'7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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I❑apectorc Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Cell For Relnep.
INSPECTIO14 NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbq. Underslab Mech. Rouqh-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. 8d. -Hoch
Date Requested: T{iintozz AM PM
Address: S / P6Ysfif �t
THE FOLLOWING CORRECTIONS 11RE REQUIREDt
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Inepec For:--------'�--''-
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rpinnp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 539-4171.
InFv�ction
: --
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL-
Pont/Beam Struct. San. Sewer Framing—____1 -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested.--2 ✓�� L ,me /, /
Address s �7 S v N~ — PA{rmi�i s !f U/�L
Builder:
THE FOI.I.OWING CORRECTIONS ARE REQUIRED:
Inspector/ /s/__f _ Dar
y APP11OM DISAPPROVED APPROVED SUBJECT TO ABOVF
Call For Reinap.
INSPECTION NOTICE
City of Tlga. . Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4.171
Inspection:_
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. Sewer (Framing -Eldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line
�7 Gyp. Bd. -Meeh.
Date Requested: Z—`;7C� —Tim%: AM PM
Address; X�3 /�s "`���_�lrmjitSA:��/
Builders ' �/" Z-C.L��cSG�I CIA-2
TBE FOLLOWING CORRECTIONS ARE REQUIREDt f- Yr'
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Inspectors ,� Date: 7-,1--,"
APPROVRD DIBAPPROVRD APPROVED BUWNCT TO ABOVE
,%
Cr11 For Aeinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Un relab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer. Framing -Bldg.
Post/Beam Mech. Rain Drain Innulation -Plumb.
P/ lbq. U do erfloos� Water Line I Gyp. Bd. -Mech.
D—at_o RR._gV 3C&a_.� ) Z "` C� 'z� TimeAM PM
2 / 1
Address: � � J��/����--� Permit #A57-2Z ��
Builders
THE FOLLOWING COPRECTIONS ARE REQUIRED: 1 D
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Inspsctorr Dater
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Lali For Reinop.
ANSPECTSON NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection._ —.
Footing 1 Pibg. Underslab Mech. Rough-in Appr/Sdwlk
nd. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/deem Mech. Rain Drain Insulation -Plumb.
Pibg. Underfloor 1 Water Line Gyp. :d. -Mach.
Date Requeot))edss / `Times AM _PH
Addreass /t7 J"�� ��/f f (/I.L �� s'err• iil/D�t+ `
Builder:�%`[.4G
THE FOI.I.OWING CORRECTIONS ARE REQUIRED:
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Inspector:, _ _--__ Date:
l/APPROVtD DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reins,
CITY OF T,IGARD RECEIPT OF V'OYMENI RECEIPT NO. :91-•2198c:6
CHECK AMOUNT : 116. 68
NAME PAVLUKOVICHO ROBERT CASH AMOUNT 111. 00
ADDRESS I -lZ--345 SW 128TH PAYMENT DATE : 11/18/91
SUBDIVISION a
TIGARD, OR 97222--
PURPOSE CIF IPAYMENT AMOUNT PA T D PURPOSE OF PAYMENT AMOUN'r v,o i r)
FLAN CHFCK FF--,"--- I16. 68
CJ
TOTAL AMOUNT PAID." 116. 68
CITY OF TIBARD RECEIPT OF PAYMENT RECEIPT NO. #91-2c'la000
CHECK AMOUNT a x'47'. 2'*.
N011f" a PAVLUKOVICH, ROSERT/DORISS CASH AMOUNT a. 00
ADDRESS a 18345 SW IROTH AVENUE PAYMENT DATE a 11/21/91
SUBDIVISION ti
TIGARD, OR 97223— if--.345 SW 128TH AVE.
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT
BUILDING PERM MIST91—iol 179. 50 PLUMB INA PERM 00
MEf-HANlCnL PE 25. 00 ST. BUILD PER 11. 48
PLAN CHECK FE 6. 25
TOTAL nMO1.JNT PAID 247. 23
BUILDING PERMIT APPLICATION TIGARD DATE •' / 19 1 .3728
THF UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDERPHDNE
OR AS SHOWN AND APPROVED RJ THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHCNE —
LOT N0, UK .---I
OWNER J.',;e BraVSOn, I;ldrd0BADDRESS 1.__ 41 SU 1;�'L'th /lyer,u,t Llellwiuci ,j
ARCHITECT
ENGINEER
BUILDER amc3 ADDRESS 11059 5E DiVisiontpu lDESIGNER Mike brayoun
STRUCTURE E)�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
IN RESIDENCE ❑ COMM D EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PA',IO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY ",ml 3.LAND USE ZONE —Fi--7 BLDG.TYPE _2 N FIRE ZONE "— PLAN CHECK BY__ dWh HEAT_0 3
Construct nitigle family duelling u/attached garae. 3 Bedrooms 3 Caths. ~
SEE CORRECTION SHEET ATTACHED,
'n SEWERPERMIT# X)JS*X%Hl '".j `2 — "750.00�— _OCC.LOAD FLOOR LOAD 40 HEIGHT ?0 NO.STORIES 2 AREA 1 717 NO.BEDROOMS 3 VALU46l g 908.
BUILDING DEPARTMENT SET BACKS FRONT _REAR 55 L.EFT SIDE 7 RIGHT SIDE _14
Permit 211.00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
�Q REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check in5.50 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 31(x• !.i0 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 4 . 4/1
SDC.— 4110 a 0l)
Total ti3,2 9�4 �¢t
PDC#T 7i.lOn•00 APPLICANT OR AGF NT
By 1 Recelpt No.
Approved duh DRESS PHONE
DATE INSP. TYPE INSPECTION REMARKS 1 PLUMBING DATE
Contractor
Pet mit No. U !f—kv
�. • Rough-in
�i•�p sf� �r� L fj/ ,--- Fixture —
� Final
HEATING
j
Contractor ,
Permit No.
Gas or Oil
Rough-in
SEWER — — ---
4
Final
v7 DRIVEWAY
Final
Storm Drainage
C
IRefn Drain)Final
CD _ —
W Sldevmlk
Curb S Street Final
Approach
EOG. DEPT.FINAL TEMPORARY CERTIPICCV
CERTIFICATE OCCUPANCY �^ Final
ATE vC N
Landaceping
Zomrng Final
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard, Oregon 97223
Phone 639-4171
Address__ Permit #
Type of Inspection _�—
The following Building Code deficiencies are required to be corrected:
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Presented to Inspector
Date
G4LL FOR REM1r PECTION
0 VES ❑ NO
BUILDING PERMIT APPLICATIONT1Gr+..��R DATE /V�• 19 g0
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR Tf iEWORK HEREIN INDICATED BUILDER PHONE Zs3418
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLIAS AND SPECIFICATIONS. OWNER,PHONES-�--
�:? p,,,u yrc . � LOT NO. 131
JOB ADDRESS 1,7-34,5- 7(0 I28 �.
MN
�fXM'l'Q• g �Q NEER
BUIL-CER
A0DHESS _1i 1! DESIGNER - �tw �
STRUCTURE NEW ❑ REMODEL A0DIT!ON ` :1REPAIR C1ENEWAL ❑ FIRED_ AAAA GE - ❑ DE+/OLI T 10
RESIDENCE C COMM ❑ EDUCATIONAL J GOVT C RELIGIOUS G PATIO ❑ CAR # 0 GARAGE G STOR GE ❑ SL-AP-0 FENCE
"j
f- .LAND USEZONE - BLDG.TYPEN FIREZONE-\PLAN CHECK BY HEAT�a�
� O
ekyocA
SEWER PERMIT N
OCC.LOAD FLOOR LOAD //O IGHT NO.Sj IES / AHEA /1227 BED r'oOMS VALUES/µ00
+'
BUILDING DEPARTMErJ SE BA S FRONT 20 REAR 30 LEFTSICE RIGHTSIDE
(Permit TH PEOMIT IS ISSUED SUBJECT YQ THE REGULATIONS CONTA(NE IN THE BUILDING CODE,ZON'TJ
f- RE ULATIONS AND ALL APPLICABL' CODES AND ORDINANCEt, AND IT IS HEREBY AGREED THAT TH
p!.in Che �'� '1� S,. WO K WILL BE DONE IN ACCORCAN)GE WITH THE PLANS AND SPECIFICATIONS AND IN COfdPLIANC
- WIT ALL APPLICABLE CODES AND RDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVF
Sub-total 2�_�'-� RESIIICTIVE COVENANTS. CONTRA C R AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
ICE E.SEPAP.ATE PERMITS REQUIR FOR SEWER,P4VMBING AND HEATING.
rata Tax
Total l
P PPLICANT OR GENT —
By
R e c 'pt No.
, Approved _ •, ADDRESS PHONE
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BUILDING PERMIT APPLICATION TIGA7:) DATE- /!a
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR ThE WORK HEREIN INDI BUILDER PHONES:?
OR AS SHOWS J AND APPROVED IN THE ACCOM,PANYINO PLANS AND SOECIFICATIONS. OWNER PHONE
a,r,coJ Sb1') B DDRESS t/` 77�� 7 •/fVf. . LOTN0.1�' —
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BUILDER 94"lle- ADDRESS 10 5F, �I�s�by� ��pESIGNER-/A1 a
STRUCTURE T'�NEW ❑ REMODEL - L"_ADDITION _❑_ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE Cl DEMOLITIO
RESIDENCE (u COMM ❑ EDUCATIONAL ❑ GOV'T ❑_RELIGiOUS Cl PATIO Cl CARPORT Cl GARAGE ❑ STORAGE ❑ SLAS❑ FE.NC
i iirANCY- L,gNp USE ZONE BLDG.TYPE— FIRE ZONE PLAN CHECK BY HEAT
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SEWER PERMIT#
OCC.LOAD FLOUR LOAD _ HEIGHT ,20 NO.STORIES AREA 7 rJ NO.BEDROOMS „3 yp.LU
BUILDING DEPARTMENT SET BACKS _FRONT �1==
__ _ _�O REAH f;� LEFTSICE RIGHTSIDE
�f rrmit 211. 00 THIS PERMIT I5 ISSUED SUBJECT TO THE REGULATION'S COQ -_�—_~
_ CONTAINED IN THE EUILDIN6 CGDE,ZON'!V
Ian Check -_ �',,�"� REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND If IS HEREBY AGREED THAT TH
WORK WILL BE DONE IN ACCORCANCE WITH THE PLANS AND SPECIFICATIONS AND IN CO3'APLIANC
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV
!Ft!Sub-total ✓ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINES
p LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
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PDC# APPLICANT 09 AGGE V'
Approved Receipt No.
ADDRESS PHONE
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SEWER CONNECTION S ?ZS'
SEWER INSPECTION S �3
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