12070 SW LINCOLN AVENUE !� r
120'iU SW LINCOLN AVI;Nl)i-;
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BUILDING PERMIT APPLICATION TIGARD DATE__-
THE UNDERSIGN'-:C IFRECY APPLIES FOR A r E.RMIT FOR THE WO`4K HEREIN INDICAI ED RUINER PHONE .._UILDER E •�
OR AS SHOWN Al 40 APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. LOT NO.. ---- ---
OWNER Jerry Edtl JOBADDRESS 12070 Std Lincoln---- RCHITECT
9NGINEER
BUILDER
0t?Iti6 ADDRESS -_ DESIGNER -_-_---.-_--- —
—..� � --
STRUCTURE ❑ NEW ❑ RFMODEL ❑ ADDITION IS REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
ISS RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO L7 CARPORT ❑ GARAGE L7 STORAGE SLAB❑ FEACE
R"7 _BLDG.TYPE — 5N _FIRE ZONE_ PLAN CHECK B-- Y -�_HEAT
OCCUPANCY R"3 LAND USE ZONE
Reale s exis_t.inusell between house amara a (metal Pirerpi�ce removed• )
SEWER PERMIT M NO.BEfjROOMS VALUES100 00-
UCC.LOAD FLOOR LOAD HEI'14t NO.STORIES AREA
BUILDING DEPARTMENT SET BACKS FRONT _REAR_ LEF7�IDk RIGHT SIDE
Permit ffi1C�.00 THIS PERMIT IS ISSUED SU3JECT TO THE REGULATIONS CONI`,Ih 1 THE BUILDING CODE, ZONING
REGULATIONS AND ALL AP►'LICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Chock WORK WILL BE DONE IN ACCORDANCE WITH 1HE PLANS AND SPECIFICATIONS AND IN CJMPLIANCE
WITH ALL APPLICABLE CODE,,' AND ORDINANCES, THE ISSUANCE OF THIS PERMI1 DOES NOT WAIVE
Subtotal RESTRICTIVE COVENANTS. CONITRACTOR AND SUB CONTRACTORS TO HAVE CURrFNT CITY BUSINES;:
LICENSE.SEPARATE PERMITS F EOUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax •40 SDC-
Total 110.40 PDC# APPGCANt OR AGENT
BY --
M pl
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Approved bcReceipt No. 7; 12 —ADDRES8-------T PHONE
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DATE INSP. TYPE INSPECTION REMARKS4Perrr;(Nc,.
PI.UMBINCi> , actor
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Fixture
Final
HEATING
Contractor
— Permit No.
Gas or Oil �!�
-` - Rough•ln
Final _
-- �
IFinal
DSRF�I.V�VEE-
WR
AY
Fina
m
Drainag?
(Rain Drain)Finah_
---- —_� $idawnik
Curb&Street Final _
Approach
t3!Dfs. DEPT.FINALTEMPORARY CERTIFICATE OCCUPANCY Finel
CEET't1CATE OCCUPANCY
Landtrap-119
Zoning Final
PERMIT APPLICATION `u Y T IC,"AD DATE'��-- t9 No3sd��
F " '.FD HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPMO-NR
AND APPROVED IN THE ACCOMPANYING FLANS AND SPECIFICATIONS OWNER �IONF�ir�.
LOT NO_
OWF1B � `�„�� JGc ADDRESS i:lc7.'r r E nDORE5I
ARCHITECT'
c. ENGINEER
Builder.._ �-�� -- A�URC•SS ._,._.._� ...rDESIGNER --
rt r ❑DEMOLITION
JqE 1�►a�W _ �. r.' I+ODEL DAOUITI_ON _�—REPAIR �— QRrNEWAL ❑TIRE D4MAGE;
., RE I —
__ - - `— - — PMO ❑_CAP PORT ❑GARAGE ❑STORAGE DSLAB ❑FENCE
_MM C7 G_ 'C_NA_L ❑GO_V'T ❑R ElIG10USU
'FOND F []VOV!NG ❑CONDITIONAL USB' —lODESIGN REVIEW []COUNCIL APPROVED ❑SIGNS _
- - BLDG TYPE _T ^ FIRE 70Nk� PLAN CHECK BYHEAT
,,.PANG _. r'D USE ZONE - —
/� .• _,r`_�_ _ - ��.� - �r., tet.__
F.!S�QiLOSQ_ - ElEisitlL___ __�Q�SIQHIF.S.-"��. __�_�lSI•BEDF00 S fspik y—Za C2
— BUILUING DEPARTMENT SET BACKS FRpNT REARr LEFT SIDE AIGHT SIDE
THIS PERMIT !S ISSUED SUBJECT TO THE REGULATIONS CONTAINED 'N THE BUILDING CODE, ZONING
Plan Check '" REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS h.:.^CBY AGREED THATTHH
WORK WILL BE DONE IN ACCORDANCE WITH THE FLANS AND SPECIFICATIONS AND IN COMPLIANCE N
�:I.b total ALL APPLICABLE. CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-L RESTRICTIVE CnvFNANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY lUSINESS
1,iatP Tax LICkNSF. SFPARATF PFFPMITS IIEOUIRFD FOR SEWER, PLUMBING AND HEATING.
otal
B — A? APPr-iCANT OR AGENT r
A;'r owed Receipt No. -
�_. AUUpE55 HONE -r
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A�e4ce
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T
j C:ITY OF TIGARD
PERWI r tlO,.S~, SME ADDRESS_ O_ ftt_.
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BUILDING PERMIT APPLICATION CITY
OF TYGARD DATE,l-Z-'� is oe ?2
THIE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONKL
OR AS SHOWN AN[` APPROVED fN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE_ —
LOT NO. _-
OWNER 11fiar1 Y.. Edtl JOB ADDRESS .". d HOML ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS ^� _ DESIGNER
E_FT UCTURE ❑NEW ❑REMODEL -S IDDITION ❑REPAIR ❑RENEWAL OF'RE DAMAGE_ []DEMOLITION
.
u'RESIDENCE ❑COMM ❑EDUCATIONAL LLIGOV'T LORELIGIOUS❑PATIO [:]CARPORT ❑GARAGE ❑STORAGE OSLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY —LAND USE ZONE t!' IBL DG.TYPE ~�[`I FIRE ZONe_ PLAN CHECK BY_ � ' HEAT_
install prefabricated fire plracs kill per mfg. rsqurL*mv6tg ana Linder BeL, U.
OCA LQAD _ FLOOR LOAD HEJ_QH1 _.— NQAIQWf,$-- AREA
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit U0
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 APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REOUIRFD FOR SEWER, PLUMBING AND HEATING.
Total .,; a
By
._ APPL,!CANT OR AGENT
Approved 1,t Receipt No.
ADDSRE55
�,e.,ly,.YwaurWW+•-�..__ __-.aw.... ' w�V..,�y —r..—: y ..�...._.y.ruuwa.�url•._._..__..IWs4....-._-........•,-• .w..:..........wurr....wtlM.Yk.aixu..Jr.aii,.._.....r..J,W:riwr+YYnerr......._-..-. Y.n.
DATE INSP. 'rYPF INSPECTION _ HLMAHKS PLUMBING DATE
(.,2.c �- --- - - -- — -------� Contractor -
Permit No.
Rough-in
— Fixture
Final
----- -- ------------ HEATING
Contractor
Permit No. _
Gas or Oil
Rough-in
--�----��— - - -- Final — --
--- -- —.
31 SEWER
Final
DRIVEWAY
Final
Storm Drainage _
(Rain Drain) Final —_
Sidewalk
Cu,h&Street Final
Approach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE 'CCUPANCY
CERTIFICATE OCCUPANCY Final _
Landscaping
llZonmg Final
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Address_ _. ) L- c
,l Z L__ �_..__�- _ Permit Na.
Name of Occupant _ Permit charge
Connection fee__
Paid by----- -- --
Date connected
Type of Building Inspection fee_
Service Rate__ �Q�_ __ Paid by Date
-ontractor Assessment Pa;d
Size of connection L,'-' III