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158,10 SW HIGHLAND COUKf
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. : .
DATE '. DATE ISSUED _...1_L_
OWNERS; NAME .' -
ADDRESS.:
CONTRACTOR .
-TF ST ' Air U, Water Ll , Visual A" Laboratory 0
RESULT' Approvedx Disapproved [I Pending r.)
SKETCH:
!/,-e4-0-00—r—,
IN1 0
"PECTOR DATE
L
City of Tigard
INSPECTION REQUES)' '
for
I
INSPECTION TIME: _ PERMIT N". :
DATE .- DATE I S S IJ E D .._._LL
i
OWNERS NAME :
ADDRESS: _J�?�_._'A 304_._
CONTRACTOR
TEST : Air ❑, Water C Vielldl,l j , Laboratory C] I
RESULT: Approved , Disapproved ❑ , ponding []
SKETCH: --
IN CTO DATE
CNOTF: Attach rupr!*mn•.tni iest .„ ,
W
BUILDINGCITY OP
PERMIT APPLICATION TIGARD DATE � •��'�� N" 0576
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYll"4PGANS rA01D �SPEAf �A moe
irMPH(�
1 Ln Dawes CO*, Incs
OWNER ADDRESS jzyUS '��+ 1 BUILpEFl PHONE
ENGINEER
RUu DER 1j
ARCHITECT _ DESIGNER
S1 RUCTURE IJNEW ❑REMODEL ❑ADDITION _ IREPAIR ❑RENEWAL ❑FIRE DAMAGE ❑ M
DEOLITION
C3 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSOPATIO []CARPORT ❑GARAGE ❑STORAGE❑SLAB []FENCE
�C IBOND ❑MOW IPUG ❑CONDITIONAL USE ❑DESIGN REVIEW []COUNCIL APPROVED _❑SIGNS
=� (� r fn
OCCUPANCY- LAND USE ZONE--BLDG.TYPE FIRE ZONE_ PLAID CHECK BY _ HEAT__ _
S.a n 4'ba4: n ilE a yard setback
OCC, LOAD _ FLOOR LOAD—_,_______ HEIGHT NO.STORIES AREA VALUE
3 64
BUILDING DEPl.RTMENT SET BACKS FRONT �.(; REAR LEFT SIDE RIGHT SIDE _
Permit 10010 _
® THIS PERMIT IS ISSUED SUBJECT TO THE REGULATI' S CONTAINED IN THE BUILDING CODE, ZONING
LQ•V
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITV I HL"LANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. rHE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
•�,�� RESTRICTIVE COVENANTS. CONTRACTOR AND
USEWER, PLUMBING AND HAVE CUPPIENT CITY BUSINESS
196 State LICE 111191i A4ff##AITI � �Q
G.
Total �1�•q0
By A�LICANI (5-1-4
Approved Receipt No.
DATE INSP. TYPE INSPEr'TION REMHgKS PLUMBING DATE
i
-:I Ly %; �`'yy�i�/G S Contractor
Permit No. 0,30-
Rough-in
0 � j/��
IT Mti '� - Rou h•in _
4* �q Fixture
Final
HEATING
Contractor
Permit No. ��$
Gas or Oil 1ta
Rough-in
_ Final
--- SEWER/ .C.7r
_ Final
---- DRIVEWAY
Final
Storm Drainage
_ (Rain Drain) Final
- Sidewalk
Curb&Street Final
Approach L
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
4
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A1)013ESS ��B .�2�x� u'. 44 PERMIT NO.
PER141IT CHARGE none
CONNECTION FEE
PAID BY
1 YPE OF BUILDING .1 DATE CONNECTED
SERVICE RATE 14, INSPECTION FEE
CONTRACTJR _ PAID BY DATE
517E OF COUNIECTION =_ ASSES5UNT PAID
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