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CITY OF TIGARD �r�*
12410 S. W. M.1s Shv e
TIOARD. ORSOM 17221
APPLICATION FOR BUILDING PERMIT
New Construction a Demolish ❑ Addition Remodel Move,
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ZONING X-3 DATE ISSUED 11-2-7& BUILDING PERMIT
BUILDING FEE $ 5.00 N `2+~n
DATE RECEIVED ---- �+15
PLAN CHECK S
BY DH OTHER $ VALUATION S 500.E
TOTAL $ ).00 � RECEIPT No.
7L..
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M 100 MAP A CENSUS TRACT Lu-1 JOB 1
Architect or Engineer None required now_
Address Phone
Owner Tigard %webouso (Ores=" Service) Earl Adsas
Address Phone
17,
Builder same
Address _Phone
BUILDING USE Single Res. ❑ Multi Res. ❑ Conan. ❑ Industria>1
OCCUPANCY GROUP 72 No. of Stories Total Height_ _ Area of Lot__....w
Type of Construction XIII 1== Floor Area B_____ 1` 2
Set Backs: Front Back _ L.Side R.Side n
Private. :ewer Pipe Size Sewer__-__ �Septic Tank
Water Service Pipe Size Storm Sewer IJ Ditch ❑ Dr?wQ11 11
Street and Curh Requirements__
Driveway width �No. of Parking Spaces94
___—�
SEI'ARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
A.
101 x 441 Storage building connected to trunk shup for Battery storage
ADDRESS ASSIGNED 1.2980 B.W. Hall Blvd.
FIELD CHECK BY BH DATE 11-2.78
PERMIT APPROVED BY
_C
it is unierstood that all work will conform with applicable codes and ordid
of the State of Oregon and the Cicy of Tigard, Oregon, and that the building
not be occupied until a Certificate of Occ ncr has een issued by the City.
Tigard Building Inspector. `
r' na ure o App cant
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