11367 SW LAKEWOOD COURT 1.1367 SW LAKEWOOD COURT
1
I
43
i4
U
O
O
3
O
v
N
J
Ln
N
t0
M
-4
J
1
l
r
City of Tiyard
NSPECTION REQUEST
for
INSPECTION T�ME: PERMIT NO. :.r
DATE:)` D9-F- ISSUED
OWNERS NAME :
ADDRESS:
CONTRACTOR : —
'FEST : Air C , Wats, Visuat-d Lol,f ratory C
RESULT: Approved,Z1 oisapproved C Pending []
SKETCH:
1
' I ,
G
_�. 4u
iNSP nR DATE
-
COTE : Attach supplemental test do$ 9 hsi
lid_ �:
PER+"IIT C H it R G L none
OWNER CONNECTION FEE
--- –
PAID BY
G _��-^�-�-��--� -
DATE CONNECTED
OF B U I l G T N
_ -
INSPECTION FEE
SERVICE RATE r� S • ..�.�.
CONTRACTOR �� ? _ — PAID BY DATE
ASSESSMENT PAID
SIZE OF CONNECTION _______.. `"�"–'
i
CITY OF bX .
BUILDING PERMIT APPLICA ION TIGARD DATE ,9V- or)0 G
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANF AND SPECIFICATION$,1i.yQWN�ERPTNE.____—
-Q-W-1ER I
f LI1t,7 I' Co. DDRESS oa 2,x7!,7 w,. LAkCluh2�O cr, d I
BUILDER PHONE
ENGINEER
$UILDER _ _ _ ARCHITECT DESIGNER
STRUCTURE QNEVN 0REMODEL 0ADDITION ❑RE"AIR ❑RENEWAL ❑FIrrRE DAMaGE [QDEMOL:T!ON
C-1 RESIDENCE ❑CJMM [ I:uUCAT'O1NAL ❑GOV'T C., =LIGIJUSDPATIO ❑CAR PORT ❑GAHAGF L I-�1STORAGE OSL.AB ❑FENCE
013ON: '–
❑MOVING L '"ONDITIONAL USE ❑DES.UN RFVIEW ❑COUNCIL APPROVED ❑SIGNS
Q _QUPANCY ° _LAND USE 7.ONE I� _BLDG.TYPE ^ FIPc ZONE—_''7 PLAN CHECK BY�' kJ HEAT__. 'W'
..,r,..'ruct 1301 ela. PL. f, ,u dwelling with attshed yarge
no bovisment according tri approvod plena reieaula 111,09 �rlt.:
^--- 3 bedroom*
Q.�S_LOAD_A FLOOR LOAD AO__ HEIGHT — _;AO.STORIES_ i AREA VALUE . O oin
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR ZO LEFT SIDE 17 RIGHT SIDE
Permit .L�' �.00
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 10100 REGULATIONS AND ALL APPLICABLE. CODES AND ORDIN<.ACES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State sEll LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEAT,NG.
Total 2,Q0, 1
APPI IU,ANI (1R AGE.NT
Approved Receipt No
AhIIRES$
DATE INSP, TYPE INSPEC'I'lOt REMARKSPLUMBING DATE
J- e
ntractor
�"1 76 L- , Com, � " t 'G' mit Na. :311 /�AJ L
Rough-in -- --
�'�7 Fixture
Final
HEATING
Permit No.
Gas or Oil 60s )dQ*20? Vkv Fm-f-76
Rough-in
Final
SEWER G 76
Final —^
DRIVEWAY 3 2 7 — '
— - - ---__- — — --- Final
—
_ Storm Draina
(Rain Drain) Final
— _—_—_- Sidewalk
—T._— Curb&Street Final
A roach _
BLDG.DEPT..-INAL~— IEMPORARY� CERTIFICATE OCCUPANCYv
� ,�-7 / CERTIFICATE OCCUPANCY Fir al
La•ids,aping
Z ming Final
�ArN
,y v
io
o