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ADDRESS PE RP1I T NLO.
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PERMIT CHARGE none
� CONNECTION FEE � rae" .
ow 1 E R 66"(44,,
h
PAID BY
TYPE orr, BuIIDING DATE CON%E-CIED
SERVICC RATE /fir" INSPECTION FEE <2 15 -
CONTRACTOR PAID BY _ DATE
SIZE: OF CONNECTION A55E55MENT PAID
17
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BUILDING PERMIT APPLICATION CIT TIGARD DAT E 14,51
f(
OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILOERP14ONE 1
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
i LOT NO-
OWNER { 11� of C UniCl� T• rOoe AD'IRESSI97C 5U f an110 i.L ttTokWave Y e !ja— rj
HOME ADDRESS
ARCHITECT
DUILDER ?l�Atli(' ADDRESS * ENGINEER
(T JX �7.�-Z� 1'Ia1�1fJ��r��i DE.S'IG'NFR
STRUCTURE ❑NEW ❑RFMr1DEL ❑ADDITION ❑REPAIR L,�RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
RESIDENCE C�COMM LJEDUCATIdNAL ❑GOV'T ❑RE'_IGIOUSG;ATIO ❑CARPORT ❑GAIaAGE ❑STURAGE_I.7SLA8 ❑FENCE
_nBdND_ ❑MOVING — ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS f
UCCUPANCV�===.i_LAND USE LONE ' � � ___FIRE lON;'.�=' PLAN CHECK BY 1. Til } _
Ai➢1
1Aj—C-
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�s4 H.ELQHJ- Z 1 711:�'t�-- tot�C.
-- d �A-I --—�1PA.,_ ND.BEDROOMc f
BUILDINIa DEPARTMENT —YAC------•--
S[r BACKS FRONT �.5 REAR 40 LEFT SIDE ' RIGHT SIDE
Permit —V
u —
Plan Check -- —=-- -- -- — _
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE 13UILDING CODe, ZONING
V01 S0 REGULATIONS AND ALL APPLICABLE CODES AND ORDINl.NCES, AND IT IS HEREBY AGREED THAT THE
WORK
Sub total WII-L BE DONE IN ACrORDANCE WITH THE PLANS AI'EI SPECIFICATIONS AND IN COMPLIANCE WITH
•1« rlLh _
ALL APPLICABLE CODES AND ORDINANCES. THE t;;SCANCE OF THIS PERMIT DOES NO' ;VAIVE
^p RESTRICTIVE COVENANTS. CONTRACTOR AND SUH CONTRACTORS TO HAVE CURRENT CITY RUfINESS
State Tax 11 — f 1 06 LICENSF SEPARATE PERMITS REOUIRFD FOR SEWER, PLUMBING AND HEATING.
Totals::0 1LJ{J.til.
l f1n.Ob
By (31
Approved
_ � Receipt No �
i
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
%/� — `— Contractors --
Permit No. /`q J z 6-0
• R 16 zough-in
Fixtura0 J /
Final
HEATING �-
Q_ �,12 L�—� Contractor
Permit No. � J� � �.3Z �` l7—'79 f�
Gas or Oil
Rough-in
Final
SEWER
Final
- _--- - --__.r---DRIVEWAY ---- --•
Final
p; Storon Drainage
(Rain Drain)Final
_ -- -�� --
Sidewalk
— ---- —__�. — Curb A Street Final
Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —__ ---.-
Landscaping
Zoning Final
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