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PERMIT APPLICATION TIGARD DALE _ _,is _ *5
THE UNDERSIGNED HEREBY APPLIES FOR A PCRMI RVR Ti IE WORK HEREIN INDICATED BUILDER PHONE 245-1131
OR AS SHOWN AND APPROVED IN THS:AC Q,M�PNYING PLANS ANC SPECIFICATIGNS, OWNER PHONE
�Cis� ...T.v LOT NO. +0
OWNER i`:K7f�t.I',1r1+.1fs.�1 CO• JOBADDRESS 7 i. ```:+ V anno CreeR Dr vi-r _
- -- --._— _-_----- — ARCHITE('T DEIh1tt X',l111f'mY1t 2*36--936`
ENG'l j( .) .114 Darbur Blvd. DESIGNER alc t'.r911cr X655 )21
I NEFIR
BUILDER F3<'�!;tt� ADDRESS - ' ; �"�`
STRUCTURE [ `NEW ! REMODEL ❑ AGDITION ❑ REPAIR ❑ RENEWA!_ ❑ FIRE DAMAGE ❑ DEMOLITION
U RESIDENCE ❑ COMM n EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ (,`R PORT ❑ GARAGE P STORAGE ❑ SLAB❑ FENCE
OCCUPANCY —&---1--LAND LAND USE ZONE. -L---12—BLDG.TYPE , ^FIRE ZONE_—PLAN ;HECK BY —c—IMI.HEAT_ Q Ic--C!-
Construct
--c_Con€ truct G unit ayort:mcnt all, per roans and code, t3La, $'a
14ycdrooms 12 vat}•r,
SEWER PERMIT#
OCC.LOAD FLOOR LOAD_ 4n HEIGHT 20 NO STORIES 2 AREA 6)('rl N_0.BEDROOMS 1 VALUE
BUILDING DEI'AR fMENT SFT BACKS FRONT HEAR LEFT SIDE RIGHT SIDE
PermitTHIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE GLIDES AND ORDINANCES, AND IT IS HEREBY AGREED THAT HE
Plan Check 21s.75 WORK WILL BE DONE IN ACCORDA14CE WITH THE W.ANS AND SPECIFICATIONS AND IN COMPLIANCF
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal _ 615,25 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTPACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 4 16494 �
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWE3,PLUMBINQ AND HEATING.
,-
SDC—
Total 692#19
By O �
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PDC# A PLI TOR+OENT
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Receipt No,
Approved ADD E ---- _ w —PHONE
DATE INSP. TYPE INSPECTION REMARKR PLUMBING DATE
Contractor
Permit No.
Flough4n
Fixture
0, Final
e
HEATING
Contractor
Permit No.
Gas or Oil
Rough4n
Final
SEWER
Final
DRIVEWAY
Storm Drsinegr
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINAL— TEMPORARY CERTIFICATE
_--
CERTIFICATE OCCUPANCY Final
Land-,Aping
7nnin9 Final