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+ to the tires t' . 11 t�!i;:ior-; 2r� r--ad'; for inr -,
(�►� hours prior
for is'I cont.�:tOrS aril s+.ib ,:'� ,:r•,.:or;.
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• _,.._�._ 15.00 �---_�
IN Iv1O'.1AL FIXTUFE FESS - ------- "�
1 to 50xtur�t ----
51 to la�l Fix•v�st in 1 'I� ,_;-3.tC, ,, ---'--- � -
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CITY
BUILDING PERMIT APPLICATION of TIGARD DATE _____--- 19--
THE UNDERSIGNLJ HEREBY APPIJCS FOR APE RM IT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE —
LOT NO.
11L'tCl{ !lY�7 CIIU 7':I 70villn Y Rl;i HOME ADDRESS
OWNER K•B ADDRESS
ARCHITECT
ENGINEER
BUILDER __ ADDRESS DESIGNER
STRUCTURE _ ❑NEW _ ❑hf'MODE' _❑ADDITION ❑REPAIR []RENEWAL [:]FIRE DAMAGE ❑1)EMOLIIION
❑ RESIDENCE ❑COMM_❑E-- D1IONAL '^JGOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑S'TORAGE❑SLAB [:)FENCE
❑BOND []MOVING EJCONu.TIONAL US6 - ❑DESIGN REVIEW -_❑COUNCIL APPROVED_ ❑SIGNS
OCCUPANCY—___ .._LANn USE ZON__ _ BLDG.TYPE_,_____.FIRE ZONE.--_ PLAN CHECK BY___.__.______ -- HEAT-.—.----
Uc4 LOAD �__��49p L9AQ_�. �i€1SiHI----J—
IES _ A_- 11`SL6ScR_44Mi _Y�LI) .__�1_
BUILDING DEPARTMENT SET BACKS FRONT REAR — LEFT SIDE _-_ RIGHT SIDE
Permit
— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICPSLE CODES AND ORDINANCES. THE ISS%IANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVFNANT`,'. CONTRACTOR AND SUB CONT AACTORS TO HAVE CURRENT CITY BUSINESS
StateATax LICENSE. SEPARATE PERMITS REOUIRFD FOR SEWER, PLUTABING AND HEATING.
1 ota
BY --- _
APPI SCANT OR ACZFNT
ApprRPceipl No
DATE INSP. TYPF INSPECTION REMARKS PLUMBING — DATE --
ec Contractor
�4121/�9 Permit No. 1975
Rough-in
Fixture — —
"L
���ArgA��V� Final
HEATING
Contractor
Pet mit No.
Gas or Oil
--- — �—�--
Rough-in --
Final
SEWER
------- Final
DRIVEWAY
Final
StorRt Drairage
(Rain Orain)Final
_ Sidewalk
Curb&Street Final
- ----- Approach
BLDG. DEPT.FINAL TItMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY -- -
Landscaping
Zoning Final
BUILDING PERMIT APPLICATION coy TIGARD OATE_/AA1_._._?__._, 19� N.
T'AE UNDERSIGNED HEREBY APPLIES FOR APE Rmir FOR THE WORK HEREIN INDICATED BUILDER PHOf'4E. ,iE:,f0_
OR AS SHOWN AND APPROVEO IN THE ACCONIPANYING PIANS AND SPECIFICATIONS OV/NERPHorIF*�T_�_____�__
LO-r NO.� �_
JOB HnoPE,.,5 �'�! ' CSG °'�Il1�ICGY' /131 93 ��✓_`
ARC'iITECT
J� _,p 2
BUILOCE� / �-1 + Mg ADDRESS �_ J�.C.(A_V_�'�-.t��S�rL^�1 ' DESIGNER r-1 ---�.�
STRUCTURE UNE W QREMnOEL _—_❑ADD�fI--TION -DREPAIRORENEWAL ,KFIREDAMACED
, DEMOLITIJN
RESIDENCE C]COMM EDUCATIONAL DGOV'T DRELIGIOUS IJPATIO CICAR PORT 0GARAGE. ❑STORAGE OSLAB ❑FENCE
0CCUPAf4CY13-P.LAND USE ZONE__ : —QLDG. TYPE`_jA4LFIRE ZON&�.__3__ PLAN CHECK BY.
lit
F LOC)A gADhj�IC,�1T _TQ jj4 A8E_ _NOQEQFIQO-M5 LUF_10-P—
BUILDING DEPARTMENT SEI'BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permt 40 CO)
TS't- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE FlUIL.DING CODE, 70NINC
Plan Check ��� REGULATIONS AND AL.L APPLICABLE CODES AND ORDINANCES, AND IT IS HERFRY GGREED THAT THE
-•b WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COIXILIA.N�,E WITH
Subtotal n;-P •� ALL APPLICABLE. CODES AND ORDINANCES. THE ISSUANCE OF THIS PERNII' DOES NOT WAIVE
— {-r RESTRICTIVE COVENANTS. CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY CUSINESS
State Tax 1• �' LICENSE. SEPARATE PERMITS HFOUIRED FOR SEWER. PLUMBING AND HEATING.
Tota! _ �� • -1 Z— pOH#
APPLICANT OR A;ENT
Approved Receipt No
SDC — $
PDC -
SEWER CONNECTION
SEWER INSPECTION Lo
SEWER SURCHARGE
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