11410 SW LOMITA AVENUE 1141C, S4 LOMITA AVENUE
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BUILDING PERMIT APPLICATION TIC ARD DATE_ ,lulr 17 19 7"N2 0002
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEPEIN INDICATED 639-1709
OR AS SHOWN AND APPROVED IN ' IF ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNER "R ADDRESS 114i0 ' Fomite _ BUILDER PHONE —
Anthony Ctansto Co. ENGINEER
BL.ILQ)JL__— — ARCHITECT DESIGNER _
S"iRUC'TURE ❑NEW ❑REMODEL ❑ADDITION _❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑D_FMOLITION
CRESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARA, ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIG.,S
OCCUPANCY ._LAND USE ZONE------BLDG, TYPE_ .—.FIRE ZONE— PI AN CI:ECK BY_ HEAT.___
QCC• LOAD _ FLOOR LOAD HEIGHT NO.STORIES AFIEA___-- 'JALUE
BUILDING DEPARTMENT
SET BACKS FRONT TEAR LEF f 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
— WOPK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITF1
Recordinq ALL APPbCABLF CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTeuCTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State •35 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total 3C• 16,
ell 4
APPLICANT OR AGEN1 1, ,
Approved Receipt No.
ADDRESS HONE'F
DATE IINSN TYPE INSPECTION REMARKS -PLUMBING DATE
7-0-ly /-�A n��T 57��r7 ,a — Contrsctor ',u 'dz _ -7-/'7-7r'
_ ,� G:_
0901 Permit Permit No.
Rough-in — — —
Fixture
Final
_ HEATING
_ --- ---_^__-' ------- — Contractor !:- -7-/7-7f/
w—. -- ----- Permit No. P- --- -
-_ Gas or Oil
_—_ Rough-in
Final
SEWER-- —
Final
DRIVEWAY
Final —
Storm Drainage —_
(Rain Drain) Final
Sidewalk
Curb$Street Final
Approach
SLOG.DEPT,FINAL TEMPORARY CERTIFICATE OCCUPANCY ~
CERTIFICATE OCCUPANCY final
Landscaping
Zoning Final
Ad
Address Permit No..
Name of Gxupant_.____ Permit charge
Connection fee
Paid by
Date connected_/0'//�
Type of Building Inspection fee---
Service Paid by - -Date
Contractor Assessment—__ --.---Paid
Size of connection
PERMIT TO COM
Tigard Sanitary District
PERMIT � 1031 DAT'R
N?
PERMIT IS GIVEN TO
OF
r
TO CONNECT' A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON- t
NECTION IS MADE AND INSPECTION OF CONNECTION TIAS BE 01 COM- I
PLETED.
PERMIT FEE PAID .. . .............TIGARD SANITARY DISTRICT
By
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µ
CONNECTION INSPECTED AND APPROVED
_� --- Date _Superintendent --