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9855 SW PEMBROOK STREET
9855 SW PEMBROOK STREET Y F— W W F— t!7 Y O O ct O W LL 3 cn u7 Ln m CT I INSPECTION NOTICE City of Tigard Building Department 12420 S.W. Main St. Tigard,Oregon 97223 Phone: 639.4171 Type of Inspection _ V"' " w�j" - Date Requested 2-/. " Time_ A.M. '_P.M. Address _-- �?�-'� --_iG� Permit #__ — ------ n. Lot �+`---- f?wner_�_ -- — Builder The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector • _-- F1 Disapproved Cute CALL FOR REINSPECTION ❑ YES 4?f NO Receipt #5639 SEWER PERMIT N? 21193 Uni';ed Sc,NNerageAgency ofWashii,VtonCounty CITY OF Ti,aard DATE 5/1/80 OWNER : James A. Moon PHONE : 539-0263 OWNER ' S ADDRESS: _9B55 SWPembrook Street TYPE OF INSTALLATION: ® BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER TYPE OF OCCUPANCY: ❑ NEW 0 SIN(;LE FAMILY ❑ COMMERCIAL. © EXIST. (PRIOR TO 7 - 1 -70 ) ❑ MULT . RES. ❑ INDUSTRIAL FIXTURE UNITS - rWELLING UNITS 1 ADDRESS OF STRUCTURE : 9855 SW N&M Pembroo!< Street PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION , PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION EXPIRES IN ONE- HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNI PAID WILL 8F FORFEITED SHOULD EXPIRATION OCCUR . FEES: PERMIT FL- E $ 25. 00 CONNECTION CHARGE 300. 00 _r SIDE SEWER INSTALLATION _ Penny Liebertz ISSUED BY OTHER _ TOTAL $ 325. 00 5/1/60 11OTI4r.: `Ir"YS OF Tit;�APPI_ICANT DATE U. t:, V:;LL Ec1!'d FC3 THIS SEWER PEPMI'T Pci. N? 211 .93 ADDRESS OF STRUCTURE 9855 SW Pernbroo4: Street TAX MAP 251-116D TAX LOT 3176 - :SYSTEM Fanno Creek LOT _ 6 _BLOCK _ OF Pembrook Heights -- DWH _ 5/1/80 _ _pl _5 1 00 !'PROVED BY DATL - _ ISSUED 3Y DA1F D . J . ' S �, 1 REMARKS _Pumr & fill existino m-ptir a��e Sta Cie,