11500 SW MANZANITA STREET �I ■u � nr �. Jnr ee � 4s
1].500 SW P7ANLANITA STREET
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BUILDING PERMIT APPLICATION TIGA--.77 DATE 19
THE UNDERSIGNED HEREBY APPLIES FORA PERMIT FOR THE WORK HEREIN INDICATED BUILDtR PHONE6
OR AS SHOWN AND APPROVED IN THF ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE �O�►
I emr gLQT PJ O..,f 24 /S 1 G A
h JOB ADDRESS I t♦Z f7 V 9604 n A
��]],, // �+ j /� ARCHITECT
BUIL✓EA 4ei eo;�"� 0 ADDRESS 6 D 3w 1 � (S�ESIGNER - (3'f(r�y�
STRUCTURE (] NEW ❑ REMODEL ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE C COMM ❑ EDUCATIONAL ❑ GOWT ❑ RELIGiO_US CC PATIO C CAR PORT 0 GAVAGE C STORAGE Cl SLAS❑ FENCE
C; — _-j gND USE ZONE _._-ALDG.7YPF- FIRF-70NE PI AN CHFnK BY � HFAT___�
�d►Mti� edr�_RdQd�'. �o� 4o tr rst. r►e .,
SEWER PERMIT M
OCC.LOA,0 FLOOR LOAD 40 HEIGHT NO.STORIES AREA _3l� NO.BEDROOMS VAL Ua—F s"vo
BUILL`INGD—EP ARTMENT SETBACKS FRONT.. REAR LEFT SI CE RIGH'TSIDE
IP9rmit _ 7�,_d_n THIS PER!411T IS SUED SU9fE .T TO THE REGULATIONS ��— a --T—
CONTAINED IN THr EUiLDING CGDE, ZOP4'N.i
EGULATIONS(ND L APf7 A8LE CODES AND ORDINANCES. G,Nn !T IS HEREBY AGREED THAT TF'.E
�pinnChack (;•00K WILL BE DONE OP.DANCE WITH THE PLANS AND YPECIFICATIONS AND IN Co,',IPLIANCE
-- WIT LL APPLICABLE C ES AND ORDINANCES. THE ISSUANCE. OF THIS PGR"AIT DOES NOT ',NAIVE
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i r .ub4otal V C�$ do RF.STRI ,SIVE COVE N3,�V .CONTRACTOR AND SUS CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE_bEPA TF.PERYIITS REQUIRED FOR SEWER,PLUNIBING AND HEAT'.NG,
State TaxD�p ��,,,.
0.
g SDG—
Total ,
POCA APPI_I A —
AGENT
-- - —
By _
Approves �. ADDRESS _ PHONE
loc - f
pC — S 1L-31—�rc.
EWER CONNECTION $
\J
EWER INSPECTION $
' EWER SIJACHARGE ?1,.,/ M (21 se1w. oklLy
"n m men C _ `/`. -zq 12"?V I Glc* t 1 xW .'�, --._..-....-------
NPU 0-maa ZRq ' P-94,4 f3o44)----78
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THE RIOUL[PRESS
CITU OF TIGARD—12420 S.W.MAIN—TIGARD,OREGON 97223
RECEIPT
DATE: - ? ____—. AMOUNT: $
NAME: _L ,1 1= _,� y CASH:
ADDRF")S: 17 ' 7jT_ J (CHECK)_.
M.O.:
•OF
FOR: ACCT. Ir PERMITS SURCHARGE AMOUNT
SEWER BILLINGS 40-364 $
BUSINESS LICENSE 05-331
PLUNIEIN.;PERMIT 05-332
MECHANICAL PERMIT 05-33'_
BUILDIN', PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV. CHARGE #1 30.567
PARK DEV. CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362.
TOTALS S R„1 U�,
RECEIVED BY -----�-1= __
PERMIT NUMSERS ASSIGNEOsT
Numbw Amount Numbw Amount Number Amount
S- -- i
tl _g4
_ RECEIPT 41
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Address SCC 5 > /` ,� zi?� Permit No.
Permi t charge_
Owner Connection fee
Paid by '..4i,�
Type of Building_ Date connected
Service Rate_ Inspection fee (j i
Contactor
L _C raid by_j nom+ ,� 1�� i� _4Date
Size of connection Assessment Paid
I
I
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PERMIT TO CON'N'ECT
Tigard Sanitary District
PERMIT N° 1090 DATE
r
PERMIT IS GIVEN TO
OF
TO CONNE(,'T ATO THE SYSTEM OF TIGARD SANITARY DISTRICTAT
�..
THIS PERMIT MUST BE POSTED ON T14DESCRIBED PREMISES UNTIL CON-
NECTION IS 51ADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $...... ..:....'...................TIGARD SANITARY DISTRICT
r{�5 By
CONNECTION INSPECTED AND APPROVED
_---- ------ - -- - — �,e-__._______,
Date __._ -_��Superintendent