Permit � ,
::: 7:: r:uum i
PE04IT
PERMIT #.......: 3WA96-0059
_ CITY 01- TI DATE IS3UEDL o3/19/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 9722 3.8199 (503) 639-4171 PARCEL: 1S125DA-CE005
SITE ADDRESS...: 06648 3W KIN8EVI[W CT
OUDDIVISION. " . . : CHARLES ESTATES ZONING: R-4.5
DL 'OCK. . . . . . . " . . ; LOT. . . . . . . . . . . " . 2+05
____-______.__--____'_*___-__'.__-____'_-____-___ ._____-____
TENANT NAME--;
USA NO FIXTURE UNITS,: . : 0
CLASS Or WQRK. . . :NEW DWELLINC UMITE:. . : 1
TYPE OF USE.....:8F NO. OF BUILDIMGSo 1
INSTALL TYPE. . . . ;BUCWR IMPERV SURFACE: 0 sf
Raoar: PATH I
.
Owner: -----------------' ---------------^----'-- FEEC -- ' '---- ---
TOM ROGERS CO%CT. type amount by fate rezpt
P 0 BOX 80152 PRMT $ 2200.00 BON 03/19/96 9S-277193
INCP $ 35.00 DON 03/1W96 ?
POaTLAND OR 97280
Phone 4|: 684-1193
CONTRACTOR NOT ON FILE
__________ __________________
Phone 4t; $ 2235.Q0 TOTAL
Reg I' . . :
------- REQUIRED INSPECTIONS -------
Ttis Xpplizaq wees to ccz��9 wit6 all thp z�s and rogaigiono Sewor Inspection _ __________ __
of VI's "inifipd Smwa;a Agency. The permit expires I80 days froo ____ _ __� _____ .
the date iss:F&. The total aoauht paid will be forfeited if tNe _ ___ _
peruit expires. The Agercy does cct goanantee the acocracy af the � __
side sewer laterals. If the ewer is not located at the oeasxreoe± _ _ _________ _
given, the installer shall prospect 3 feet in all directions fro __ _ ___
the distance given, If cat sa located, mr shall p.rchae ______ __ __
a "Tap and Side 8e:er" Poruit and th i ___ __ ___ ___
' _____-__'
Peritbee Ci ' t ~ / ^� _ __ ___. ____
- � __ --
-�azed Dy : wv�, . ___. _ � _ ______ ____
Cali for inspection - 639-4175
.
.
9 6 ~- /' i' ~~