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BUILDING PERMIT APPLICATION Co'� TIGARD DATE_ � _____,19 `8
TH" UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE --�
HONF PWNER '.,��✓`"+��
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER
OWNLR r .'j y1ar, LQsI�Y� % 108ADDRESSuVr, Stj SuI11111fercrest DR HI
ARCHITECT
ENGINI-ER
BUILDER ADDRESS§ DFSIGNER
STRUCTUR_E ❑NEW ElRF'MCIDEL MADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE [:]DEMOLITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑REOGIOUS❑PATIO L_.ICARPORT ',GARAGE ❑STORAGE❑SLAB []FENCE
❑BOND — ❑MOVING L iCONDITIONAL USE ❑DESIGN REVIrW []COUNCIL APPROVED ❑SIGNS --
OCCUPANCY_Ri_'•'LAND USE ZONE.Lw l —BLDG.TYPE'1 -- FIRE ZONE__' PLAN CHFrK BY.___;,�: HEAT----,—
instruct
EAT---,—instruct. addition to ";'Astlnq single f8mily owull illy - Add oath ROOM, _-
--� r;,.pnrats c1urmi.t, faequirsd ;or Plumbing
--a — ABE90[ NIL �S €SCC_�QA
BUILDING DEPARTMENT SET BACKSFRONT 9K REAR LEFT SIDE ,--,RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE nEGULaTIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan tk4 REGULATIONS AND ALL APPLICABLE CODES AND ORCINANCES, AND IT IS HEREBY AGREED THAT THE
- WORK WILL BE DUNE IN ACCORDANCE WITH THE PLANS ANO SPEC FICATIONS AND IN COMPLIANCE WITH
SubtALL AP^LICABLE CODES AND CROINANCES. THS ISSUANCE OF THIS PERMIT DOES NOT W41VE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORSTO HAVF CURRENT CI rY BUSINESS
State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
TotalBy APPI ICANT(7R Ar1F^!TApprprcmpt No Frio
T47-
AOLIRI-SS
REMARKS
PLUMBING DATE—
DATE INSP. TYPE INSPECTION —
Contractor
— ,,^,rmit No.
Rough-in
Fixture
/•7 'L ( ��=— Final _.
HEATING --—
,��` �Z � s NS►�,S _`ti ��R
Contractor
Permit No, ti
Gas or fid
— — — Nough-in
-- — -- Final
- SEWER
-- Final -
-- — DRIVEWAY
---- —_ —— Final
Stornn DrainagE
(Rain Drain)Final
- Sidewalk
'-- Curb&Street Final
-- -.. -— Approach
BLDG.DEPT.FINAL '}'EMPORARY CERTIFICATE OCCUPANCY Final 1 _--
CERTIFICATE OCCUPANCY _L—
Landscaping
Zoning Final
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PERMIT TO CONNE, CT
Tigard Sanitary District
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pi�RMIT N? 11S7
DAT>�
PERMIT Is GIVEN
(2F _— --
TO CONNECT A -
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST RE POSTED ON TIIE nFRC,RIBED PREMISES UNTIL CON-
NECTION Is MADE AND INSPECTION OF ('ONNECTION HAS BEEN COM-
PLETED.
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M ,.TICiARD 1TARDIB RL
PERMIT FEE PAID �.. ••
('ONNECTION INSPECTED AND APPROVED
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Address �f�_�1� .�,��.1iet,�� Permit N(-)._ a9f 7
Permit charge___-- _
Owner p� .�1`- , Connection fee A.�-O
Paid by p
Type of Building--A?A2_ Date connected f
Service Rate Inspection feelQ
Contractor _ __ _ "_ Paid byDate
Size of connection__�' _ Assessments_ Paid