16020 SW QUEEN VICTORIA PL CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE , 19 N2
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED / —�®lg
OR AS SHOWN AND APPROVED ?N THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE t0 ,
OWNER E /)p R, Z:0Alm ui e RESS / S %/i/T.Y. BUILDER PHONE s
r
1 ER
3UILOFFj 1164A-k-1-15 .� CI ECT i DESIGNER
STRUCTURE ❑NEW 0 REMODEL ❑ADDITION FREPAIR ❑RENEWAL DARE DAMAGE ❑DEMOLITION
RESIDENCE ❑COMM OEDUCATIONAL OGOV'T ORELIGIOUS OPATIO ❑CAR PORT ❑GARAGE ❑STORAGE DSLAB ❑FENCE
7BOND El MOVING ECONDITIONAL USE El DESIGN REVIEW OCOUNCIL APPROVED 0SIGNS
OCCUPANCY LAND USE ZONE BLDG.TYPE FIRE ZONE_ PLAN CHECK BY HEAT ,
01 V e) &: CLItCLi\-4j)/ tirgill'1.0 ft /1-"")A4C0 PdjL6" 1
OCC. LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE
(.4
/9
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit l
l r -?-1/90 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 11 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
IfI
(., t
WORK WILL BE DONE IN ACCORDANCE.WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
ecording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
, r Q RESTRICTIVE COVENANTS. CONTRACTOR A . JR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
%State I l-t b LICENSE. SEPARATE PERMITS REQUIGED FOR vER, PLUMBING AND HEATING.
Total �I t , q
`
..--t" e9-4,417L----
by It-- �P�IANT uti {N�_rL A '
Approved ; l Receipt No. '� 13�' . e e a L-.-T )7 3
ADDRESS PHONE
of
6W-7-4—Ye
fCO '- 7.-x7.77 t ,.
I,
ry
KINalrEN--STRUCTURAL CHANGE REQUEST
Member
Date 7— /I— 7;7
Address �t ca ����- :,:.
Phone e225,
TYPE OF CHANGE
(Patio Cover, Room, Fence, etc.)
PLAN: DIMENSIONAL AND MATERIAL DETAILS
y - 3 ;,L.1 /--4er" �-
Ce} —
Note:
1) Adjacent property owners will be informed of the requested change.
2) If there is an objection, the objection, but not the name of the objector, will
be given to the member asking for the change.
3) The Board of Directors of the Civic Association will review the plans and property
for approval or disapproval and compliance with the stated restrictions.
L ) A building permit must be obtained from the city for all improvements costing over
3500.00
Date Notified KCCA Board of Directors
President
Date to be Completed ( Approved Vice President
Final Inspection Disallowed Reasons)