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BUILDING PERMIT APPLICATION TIGARD DATE 19 ,e_ 4798
THE UNDERSIGN ED 1-1ERF BY APPLIES FOR A PLRMIT FORTH E WORK.HEREIN INDICATED BUILDER PHONE 6 U-741G
OR.'%S SHOWN AND APPROVED IN TNF ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER EpyL JOB ADDRE=SS '/l�;i _Sw IlgTth�L yt�__-___^
ARCHITECT
ENGINEER
BUILDER _; e ADDRESS /f" f . DESIGNER _
STRUCTURE a NEW ❑ REMODEL ❑ ADDITION 17 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLI TION
RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO L� CARPORT ❑ GARAGE C] STORAGE ❑ SLAB❑ FENCE
OCCUPANCY --A= LAND USE ZONE 1;-IPP BLDG.TYPE _��'I.__FIRE ZONE PLAN CHECK BY . n HEAT CAN
Construct single fwAly dwelling w littachad
SEWER PERMIT M _26512 " garages 09
OCC.LOAD FLOOR LOAD HEIGHT 20+— NO.STORIFS 1 AREA 125`.' NO.BEDROOMS 3 VALUE 61,000,
BUILDING DEPARTMENT SET BACKS FRONT 2U REAR 33 LEFT SIDE ,..,; RIGHT SIDE �_{J
Permit 15sUU THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
_ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 205.40 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALI. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal S?.1.40 — RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 12.64 LICENSE.SEPhRATE PERMITS REQUIRED FOR SEWt:R,PLUMBING AND HEATING.
�._ SDC—
Total 534.1.)4 � I
PDCN (JU.UU AP*L�7���11dBy
Receipt No.
Approved f Tt ADDRESS`__�--_.___..._ PHONE
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No. 7
40(
I'Rough-in
Fixture
Final
42Z r
HEATING
Con tractor
Permit No.
Ga.or Oil
Prugh-in
Finall
SEWER
Final
DRIVCWAY
Flnel
Storm Drainage
iRain Drain)Final
Sidevvelk
Curb&Street Final
Approach
BLDG. DEPT.IFIWAL Tf�m–PO—P–ARY –'--T–E–F5i--r`IrjTE OCCUPJ Ncy1" ,
�CERTIPIOCCU""I"-.y
CATE 1 LLT—T
1-a-idscaping
L7._:mg(ural
Bu i 1 d i rig Perm i t No. _ _✓7��'`
Location �' �:
Uat e �glt2d 1
Certification of Registration
With the Builders Board
doing business as (dba) ,
ICM 4)L- registered wider the provisions
of ORS Chapter 70 Oregon Nomebuilders Law) .
fly Builders Board Registration Number is
My registration is in full force and effect and expires on
ignature..
LI-7 I
BUILDING PERMIT APPLICATION TIGARD DATE___-- 19`_
THE UNDERSIGNED HEREBY APPLIES FOR A PERIMIT FOR TFiE WORK Hc, -ATED BUILDER PHONE(e���
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND:,PECIFICATIOt S. OWNER.PHONE _
/� L TNO.1�Q
O'PJNER C � ��� - `JQ
sL — � BADDRESS ��_�
ARCHII ^T
ENGINE-
BUILDER JL��1�1�� ADDRESS DESIGNE!
STRUCTURE XNEW ❑ REMODEL. ❑ ADDITION _ 0 REPAIR ❑ RENEWAL L FIRE DAMAGE ❑ DE AOLITION
RESIDENCE 0 COMM C] EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE '=1 STORAGE ❑ SLAB❑ FENCE
OCCUPANCY l"'Z LAND USE ZONE rFZ1n BLDG.TYPE _s�FIRE ZONE—PLAN CHECK BY/-�h HEAT G A
_�,t jr, /_l• r/i2J L ' `�� yam- _ -
SEWER PERMIT k
OCC.LOAO FLOOR LOAD HEIGHT �J f�NO.STORIES 1 AREA ' NO.BE J VALUr jjf QO
BUILDING DEPARTMENT SETBACKS FRONT U 1 R�^.t? �� LEFT SIDE S v RIGHT SIDE a
POtT11iL —�1 1�"' THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
PlanCheck _ �Z�I `1� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
1 WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV:.
I
Sub-total �Z , �U' RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1�
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLU1.WING AND HEATING.
;slate Tax __
SDC—
Total �._.----__----
M �- PDC* APPUCANT OR AGENT
By
Receipt No. —-- ---
`Ap ^"4_ ADDRESS PHONE
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POC _:1
SEWER CONNECTION
SEWER INSPECTION
SEWER SURCHARGE S � �.
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