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12075 SW LINCOLN AVENUE
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CITY OF TIGARD
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TtGAMD. C446M "IN
APPLICATIOt FOR dUILDIN+.: PERMIT
new Covatruetion IL Demo Iish Addition 0 Nemcit"01 O Move lJ
ZOtiING_P-7 DATE ISSUNUt. .� Hu1LDING PSN41T
HUILDINO FRF: 1_,&.per_, Nn.
UATE RF:C::IYBD_ �_ _ T3-15T _
PL" r.H[CK S ik.SO
hT11EN f VALUATION $ .00
TOTAL i M3.S0 REC L'T PT W.� 41)/ _
r4o SLTS Or PLANS AND PLOT PLANS OUST sr. rURN:_'!!9!D WIT11 APPLICATION
LRT 1_ MAP 1CENSUS TRArr _.. .. ion 1—
Architect or
Address .__ _._ _�Y__-.__..____Phone
Address_ j!Y'lwiaiia_tjEif1 in Ala. _ _ __�.�.__�.. ____Phone–
skit I J e r
Addrs __Y Phone _
BUILDING USE 5311,116 Res. F,Xj Multi Res ❑ Comm. ❑ Industrial❑
k'CUPANCY GW)UP No. (:f Stories Total 11eight Area Of Lot
Type of Construction 1 11 111 IV V floor Area 9_
!,et Becket rront _ t13CK___ L.Side R.SideM
Pr>vats Sew*r Pile Si ee� Sewer `_ ySeptic Tank_l_J
cater Service Pit)'e Sit* __ Storm Sewer l__J Ditch � Drywall
Street and Curb Requiresrente
Driveway ':/dth _- -- __ No. of Parkinq Spaces_____
!tEPAP.ATE PERMITS RF:yt1IRED foR SKWER AND PL'_1MHI-4G
SPECIAL INriRMATION
AUDRESS ASS1G`EE0��_.�_._.... M, lrLr►coLl�3'lt_�_.
f'IELU CHECK BY EC DATE 1�13�71
PERMIT APPROVYI) BY :`�• _!ti~��/e s_
It is understood that All work will conforim with applicable codes tnd ordinances
of the State of ')ipgon and the City of Tigard, orerlon, and that the building wl.1
not be occupied until a Certificate Of yh"
igs,jod by the City of
Tigard suildinq Inspector. ""
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Address li �.(+ -44�J Permit
Name of Occupant__ Permit charge
_- Paid by
Date connected
Type of Building Inspection fee
Service Rate Z {% _ _ _ Paid by Date
Contractor _ Assessment_ Paid
Size of connection_1
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