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10855 SW FAIRHAVEN WAY
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WASHINGTON COUNTY PLANNING DEPARIMEPT
BUILDING DIVISION
REQUEST FOR INSPECTION
ADDRESS pe
BETWEEN
OwrJER
- CGNTVACTOK-��
No
READY FOR INSP,7CTION
f WASHINGTON COUNTy PLANNING DEPARTMENT
BUILDING DIVISION
Deft—
BUILDING INSPECTOR
BUILDING PERMIT APPLICATION 11T TIGARD DATE_HJT it 22
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHON,
OR AS SHOWN AND APPROVED IN IHE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_
11 �A)o- j LOT NO._._
OWNER ^• Moder JOB ADDRESS �'Viai:JL SU b 1arh8Y6in HOME ADDRESS !-
ARCHITECT
J C .net. ENGINEER
BUILDER ADDRESS DESIGNER
SSTTRUCTU_RE ❑NEW ❑REMODEL ❑ADDITION ❑REPAIR- ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BONG �L_JMOV ING ❑CONDITIONAL USE _ ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY T .. LAND USE ZONE._ '14 ____BLDG.TYPE__F I.RE ZONE PLAN CHECK BY----= HEAP +.�i31iro
Cranat, mdd lti,,�n to existing residence 161 - d" X 220 - 311
iiuw sink locFir%Jc)n. ill per code ren. and plan,
Q.IQQ. LOAD --__FLOOR LOAD_ ____ HEIGHT S __N_Q.STORIES 1 AREA 3741 NO BEDROOMS VAL,JE
BUILDING DEPARTMENT SET BACKS FRONT ••alfa REAR 1 0 LEFT SID941MO RIGHT SIDE
Permit 44,00
nQ THIS PERMIT IS ISSUED SUBJL';T TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan CheckT �
aREGULATIONS 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
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THL IS6 DANCE OF THIS PERMIT DOES NOT WAIVE
i•90 - RFSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS 10 HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 7.9P
By s..
_ nPPI.ICANT OR AGENT -----.__._,...------_—__-
Approved --- - PFS( ,jo Ni, I �. �� " .�
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Joe /t.li� _ ermit No.
LM
Rough-in fi
a
Fixture_ _
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough in
Final
SEWER
_ Final _
DRIVEWAY
F.nal
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street F;-.a!
Approach
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY i
r Landscaping /
Zoning Final l
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