12175 SW LINCOLN AVENUE 12175 SW LINCOLN AVENUE
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6LJILDING PERMIT APPLICATIGN CITY TIGARD DATE.__
OF
I HF UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE____
Ch AS SHOWN AND APPROVED IN THE ACCOMPANYING! PLANS'
LANS AND SPECIFICATIONS OWNERNO.
PHONE
LOT.'UB 12175 _i
, n'101r4 HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ONEW ❑REMODEL ❑ADDITION C3 REPAIR ORENE-WAL OFIRE: DAMAGE ❑[3DEMOLITION
L3 RESIDENCE
❑LW []EDUCATIONAL OGOV'T CIRELIGIOUSOPATIO []CAR PORT OGARAGE Cl!,T )RAGE[_1Sl AB (_]FENCE
CIBOND OMOVING CICONDITIONAL USE DESIGN REVIEW OCOUNCIL APF'4CVE0 OSIGNS
OCCU ANCY-1—L—ANDUSE 7 7 EZONE_.�_ PLAN CHECK BY` <.I1 HEAT=-_=-=..
.QNEM_1_6L0G.TYPE FIR
t all to Existi_q C
_Ear2ort.
FLOOR_LOAD HEIGHT NQ STORIES . AB1A_N_Q_0EDRO=_—Y&.UE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit _5,()()__ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUIL13ING CODE, ZONING
Plan Check REGULATIONS AND ALL APVLICABLE CODES AND GrJIDINANCES, AND T IS HEREBY AG��ED THAT THE
WORK WILL BE DONE IN ACC710ANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF 1HIS PERMIT DOES NOT IVAIVE
RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
3fste-,Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SEWEP. PLUMBING AND HEATING.
Total
Bv W-P-FD1 ANT OR AGENT
Approved Receipt No PHON
WDE)FIESS
DATE INSP. TYPE INSPECTION REMARKS EFixture
MBING DATE
, �.2 ,-
Final ---
-^- — — HEATING
Contractor _
Permit No.
Gas or Oil
Rough-III --
---- Final -- -
- ----------- -
-------- —
SEWER
Final -
DRIVEWAY
----------_..--- -- Final
Storm age
(Rain Drain) Final _
Sidewalk
Curb&Street Final
A roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCU°ANCY
Landscaping
_ I —
Zoning Final i
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Address_ Permit No.
Name of Occupant ,, Permi/�tPcharge rne
Paid by---- -
01-
_ Date connected / ' �y L
Type of Building _ Inspection fee.
Service Rate___ ___ Paid by
Contractor Assessment Faio
Size of connection—. 64 ___