11530 SW LOMITA AVENUE 11530 SW LOMITA AVENUE
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BUILDING PERMIT APPLICATION 1OFY TIGARD DATE 27-11' is
THE UNDERSIGNED HEREBY APPLIES FOP ^ PEHM!T FOR THE WORK HEREIN INDICATED BUILDER PHONE ` 2" J-4 31 _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE__
L.OT NO.. —_--
OVJNEIt JOBADDRESS .11 .-30 WL0jnit.1.: HOME ADDRESS _
ARCHITECT
BUILDER ADDRESS ENGINEER
_
-SIGNER
STRUCTURE
SSTyR11U44CTURE ❑NEW ❑REMODEL X IW n ADDITION N QREFAIREIRENEWAL [-]FIRE DAMAGE ❑DEMOLITION
lJ RESIDENCE_COCOMM ❑EDUCAT'IONAL_ ❑GOV'T' l_1RELIGIOUMOATIO ❑_CAR PORT�OGARAGE 0 STORAGE❑SLAB C'FEN--E
OBOND ❑MOVING ❑CONDITIONAL USE El DESIGN REVIEW CICOUNCIL APPROVED ❑SIGNS
OCCUPANCY----LAND USE ZONE BLDG.1 PE_ -_FIRE ZONE_ PLAN CHECK BY HEAT
srIM.- Pfitl J CaU®r_p 1- 01,8116 an
Q".—L.QAl2 __ FL-QQR�pAD 1,000,
__ — �..E!_C.H-r
dUIL..JIW_G DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit i f'I.i1� — �-
--- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE EUILDING 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 A140 IN COMPLIANCE WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PEFIMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE 'URRENT CITY BUSINESS
Stah�Tax_ •41.1 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 4(1
By + — ' --- ----- —_
--��-_ APPLICANT OR AGF N f
Approved ivcvipt No s _
- --' --_..----- --- --'fir.-. — ----..
i
Address Permit No.
Name of Occupant_ Permit charge _ _
Connection fee
_-- -- Paid by_ (',c
Date connected I�j
Type of Building v - Inspe.+ion fee
Service Rate �'� ; Paid by E, .0 oc/, Date y-/A e�3
Contractor• E �L oC.� �'!+ AssessmentPaid
?ize- of connection �
F
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 744
of010
G`-'�' '�_._..._
TO CONNECT
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT 1 y� �5�1-q—
THIS
fTHIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NEC'PION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED. RR
PERMIT FEE PAID .... ...........................TIC Alt ARY DISTRICT
CONNECTION INSPECTED AND APPROVED
---- --�. — ----._.--_-_
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