12260 SW HALL BLVD I
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12260 SW HALL BU!LEVARU
BUILDING PERMIT APPLICA110N TIGARD DATE
THE UNDERSIGNED r FRE APPI_' FOR F PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE ---
0R AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—_
a ' LOT NO. t-=-
OWNEq '.'k> �,i.,.� -r,f? £ JOB ADDRESu (i"< -
- — `v --�-' ARCHITECT
740^ "F 11111y4sttkio PAIL
ENGINEER
Tay <; f't)115t1r. t..'O. ADDRESS DESIGNER
BUILDER �8� —_
STRUCTURE .7 NEW_ _❑_ REMODEL _❑ ,ADDITION _ "Y REPAIR ❑ RENEWAL ❑ iM DAMAGE _ ❑ DEMOLITION
RESIDENCE ❑ COMM I] EDUCATIONAL ❑ GOV'T ❑ RELIUIOUS ❑ PATIO ❑ CARPORT 12 GARAGE Cl STORAGE Li SLAB❑ FENCE
OCCUPANCY -_22_LAND USE ZONE BLDG.TYPE r�' _FIRE ZONE""' PLAN CHECK BY H F AT
-0
SEWER
[�ttx'7lc'iF C�'il]f,E'rl. ??�! t2'�!+� fitZ�rtr C�tlt1T`rs t�tl1t47tC)T:" ; -
SEWER PERMIT N _ — __—__--- ---- --—
OCC.LOAD FLOOR LOAD (`r>nc*,NEiGHT _ _ N ).STORIES l ARFA NO.BEDROOMS VALU6t ,
BUILDING DEPAP,TMENT _— SET BACKS FHON i REAR _ LEFT SIDE RIGHT SIDE
Permit " . ' ' _ THIS PERMIT IS ISSUED SUBJECT TO T4E REGULA71ONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREEC' THAT THE
Plan Check _-�WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCF
WITH ALL APPLICABLE CODES AND ORDINANCES. TW-1 ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUP. CONTRACIORS 10 HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
--- - 1 SDC _ _
Total NK_AtRfOFtAGENTPDC# �—
By
Recelpt No.
Approved - _ v{ AOGRE88 PHONE
M
DATE !NSP. TYPr INSPECTIO REM/ KS PLUMBING LIATIM
Contractor
Permit No.
77, Rough4n
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Aouqh-in
Final
SEWER
Final
DRIVEWAY
Final
storm Drainagis
(Robin Drain)Final
Sidewalk
.urh&Street Final
Approach
HLDM DEPT.V-11TA—C F- TCM PORARY CURTmEATE occupF r_,na,
1CWrInCATIM Y OCCUPANC3
Approach
Zoning Final
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Addroa ? � macg ��_ Permi► ilo._�u
h3me of Occupant.,; LL-—L rrt,YUjAo/ Permit chargo_
Connection fee
--- - Paid by---- ------ - -----
Date connected
Type of Building k 10-n.— _4d, Inspection fee
Service Rate_ Paid by Data
Contractor _ Assemment _Paid {
Size of cons.aioa, � .�_
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