Permit (77) Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
1a
Jobsite Address: 35&i ,J GO L i c Yl
Subdivision:Clks4t-G iii(I A 3 Lot# �� i. Office Use Only
Valuation: --%- C., (' Contact Date !' ! Initials
:-'----:Result.-:-:-:-
New Construction Only: (Square Footage)••---- -- Planck/Rec# O /
House: f; --tin C E Permit# -,5c/P976.'•04-:?c9
asap
• Reissue of
Map& TL# , 570-41R,•41-.--C31•5"-Z--
' Corner Lot? Y N Flag Lot? 'Y N Zone !2-I d
Owner: (/(1'�'�1,..Pj& f a p Ell & 17 C'_.— Plat
Address: 6-0005�t.(1 /�'1 F1 3
Address: -.14. Approvals Required
Planning Se
tbacks Solar i , O5Cid9oOl 97o36 iEngineerng
Other
Phone: ( .f7•b3 ) 620 --'1538 1 392 P
.[ Items Required
Contractor: is wYl 6 0Of,Vyf 6‹ . ,E'
�ox4
Subcontractors
Address: o � Truss;DetaiCs . :. .
CI- cK L/Y1 A,S ® t 470/� Other
Notes3 �3
Phone: ( 5a3 ) CoSS'_ 26 S'S— ---r .--------:-;.::----. .-:-
Contractors License # 32227
.(attach copy of current Oregon license)
Contact Name: p0/Yl t t OR'f V / C I't 1-StE' F L.
Contact Phone: ( 503 ) 5.'73-‘42.../0 to20-753Y .
Subcontractors: Architect/Engineer: C iJ+1
Plumbing: 1'1\tom Address:�O o c (P11) 53) 5-20o Sw mAcRd�.�r!
Mechanical: h\n Oi; 4--uric; 0� ��2O(
(attach copy of current OR Contractor's License) - : -
) - 2 cPhone ( SO3 . ZZ6I
JOB DESCRIPTION: I--f yIc.E O -i )OC K W A �I
4503 ''620- 7'3P
Applicant SignatureApplicant Phone number
Received by: . Date Received:
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'Permit* Account Description Amount Amt Pd. Bal. Due
Bldg. Permit (BUILD) /
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
lr6�
State Tax (T'
Bldg;
Plumb:
Mech:
r
Plan Check (PLANCK)
Bldg:
Plumb:
Mecli:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF.MT}
Commercial TIF (TIF-C)
Industrial TIF (TIF-I)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS}
Erosion Cntrt Permit '(E.RPRVI T)
Erosion Planck/USA (ERPLAN) N
Erosion Pfan ckICO T. (ER •
OSN)
TOTALS 7== =
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