15525 SW ROYALTY PKWY ITY
:3!JfC_D G 'E 'MIT APPLICATION SOF TIC RD DATE __—, 19 • N9
-, , UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF __
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONF
LOT NO.
/crR ,///�� . �OB ADDRESS � ��_. -�/�, HOME ADDRESS ��'�
IARCHITECT
04; / ENGINEER
"'SER fl ��C—_o"Q "-C '.DRESS DESIGNER
JCTURE ❑NEW ❑REM**EL ❑ADDITION cariEPAIR DRENEWAL ❑FIRE DAMAGE ❑DEMOLITION
ES!DFNCE 414COMM ❑EDUCATIONAL ❑GOV'T ORE LIGIOUSOPATIO ❑CARPORT ❑GARAGE ❑STORAGE❑$LAB ❑FENCE
']BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW DCOUNCIL APPROVED DSIGNS
.l.CUPAN ____--._LAND USE ZONE BLDG.TYPE ,.FIRE ZONE_ PLAN CHECK BY HEAT
_�c� Q 1
l0 m it.", /AA, /
-2';C: OAD FLOOR LOAD HEIGHT NO. STORIES AREA NO.BEDROOMS VALUE ,,,O
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE q/rermit
THIS PERMIT IS ISSUED SUBJECT TQ THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
l Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
`tate Tax g‘ LICENSE.
LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total f .3
By-_— % ^ APPLIC N OR AGENT 4 6-44-3 /
Approved Receipt No.
___-- — - ADDRESS PHONE
RING-CITY-STRUCTURAL CHANGE._REQUEST
Member Raymond A. Earl Date 9-2-77
Address 15525 S. W. Royalty Pkwy Phone 639-3041
TYPE OF CHANGE
(Patio Cover, Room, Fence, etc.)
PLAN: DIMENSIONAL AND MATERIAL DETAILS
New black composition roof. fi ,.
240# Sealdom Shingles p .•
Metal all edges.
15-year warantee.
Rora Reese Roofing Service
16634 S. E. Tibbetts
Portland, Ore. 97236
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 Vice President
Final Inspection Disallowed (Reasons)