9840 SW KIMBERLY DRIVE-1 6 ti,
9840 SW KIMBERLY DRIVE
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A R.+ PERPIIT N .` .`] .�-•
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PERMIT CHARGE none
1111E1 � � Cor,,NECTIOP! FEC ADO• --
PAID 8Y17-
TYPE OF -" JILDING CA'+ E_ COW,[CTED v
SE'"VICE RATE / $, _ INSPECTION FEE � oz
CONTRACTOR PAID BY r. DATE
SIZE OF CONNECTION
ASScSSMINT __ PAID
SEWER PERMIT ' � ��- �-'Y
NY 15924
Unified Sewe,rgeAgancy Tigard
of Washingtw,Cov:rty CITY OF DATE
OWNER : _ Ken Backley PHONE :
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
ASUILDING SEWER ❑ BUIL.DING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
UI;1EW XOSINGLE FAMILY ❑ COMMERCIAL
❑ ,-XIST. (PRIOR TO 7- 1-70 ) ❑ MOLT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
ADDRESS n'� STRUCTURE : 9840 SW Kimberly Dr.
PERMIT CONDITIONS: THE APPLICANT AGREES TO C014PLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN.'. CALLING FOR INSPECTION ,
PLEASE REFEf- TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED ,AND TWENTY ( 120 ) DAYS. THF AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR .
F- .ES:
PERMIT FEE 5 25,
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATIONB. Greene _
OTHER ISSUED BY
TOTAL. $ -25.
1� (/6- ((,--�Uf/o 6— c7
APPLICANT DATE
SEWERPFRMI N'•' 15904
T
ADDRESS OF STRUCTUPE 9840 SW limberly Dr.
TAX MAP TAX LO 1' --- SYSTEM fanno creek
L.O T 27 _B L.O C K _ OF
E Walden - 5-27_78
APPROVED BY DATE --�- ISSUED FiY DAME
D. U . ' S 1 REMARKS �� bldg. #2ml2
BUILDING PERMIT APPLICATION 1oF TIGAR®
THE UNDERSIGNED :itREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE_ _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE_,
LOT NO._ ___—,__
OWNER Eyypti +, JOB ADDRESS Jbi dlfl
---'�-+— i 011,06 1 s HOME ADDRESS
ARCHITECT
BUILDER P3 1(YI J ENGINEER
ADDRESS r _DESIGNER__
STRUCTURE EW 11.R_1MODEL ❑ADDITIONU
_ RE°AIR QRENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RUIDENCE C:COMM_❑EDUCATIONAL ❑GOV_T ❑RELIGIOUS❑PATIO ❑CAR PORT_ ❑GARAGE ❑ST'ORAGE❑SLAB ❑FENCE
_ CIBCIND ❑MOVING — ❑CONDITIONAL USE ❑DESIGN REVIEW IJCOUNCIL APPROVED ❑SIGNS
OCCUPANCY '�
LAND USE ZONE "' BLDG.TYPE__ .FIRE NE,.I= PLAN CHECK BY Oti.,; HEATS ,I�
ranat• �-
-
OCC. LOAD.-___-�.F1,44H-LOAD _-- _ HEIGI(T -- NO SOF?IES AREA} NL.BEDRoQM$ +:l VA-LSlE_�1�'w':,"'
BUILDING DEPARTMENT ' RIGHT SIDE
_._ SETBACKS FRON r ,�j REAR � LEF i 51DF: 1)') I ;
Permit _ -- ----
THIS PERMIT IS ISSUED SUBJECT TO THE REGUL J+iIONS CON".AI'JFD IN THE 13LIlLOING CODE, ZONING
Plan Check REGULATIONS ANC ALL APPLICABLE CODFg ANO ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE- IN ACCORDANCE 'vITH TH'PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Su-b-total 01) ALI. APPLICABLE CODES AND ORDINANCES. THE ISSUQP..CE OF THIS PERMIT DOES NOT WAIVE
RN
FSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE Ct;RRET CIT` BLISINFSS
State Tax 8.25 LICENSE. SEPARATE PERMIT'S REQUIRED FOR SEWER PLUMBING AND HEATING.
Total •U•C
• S40L;,
B ar rC "2
Y
---
APPLICANT OR AGENT __--------- -
Approved Hof,,pt No
77 —._. —
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
11
-,I �a—'�— Contractor
% �v Permit No.
Rough-in
Fixture
Final
f HEATING
Contractor
Permit No. -7/4/79
QLs or Oil
Plough-in
]Final
7-Z'Y- Ai Se
SEWER
Final
DRIVEWAY
Final
�S—`-rvn DralF Ige
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG, DEyT.FINAL TtIMOORARY CERTIFICATE OCCUPANCY[ Final CERTIFICAT a OCCUPANCY
Landscaping
Zo.)ing Final
v
3UILDING (KRMIT APPLICATION CN2
OF T!G RD DATE—J!S _ r�i!_. 19�.g
Ht PNtit H�.I(,NFU HLREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE `
� .e
L'R AS SHO1VN AND APPROVED IN THE ACCKP1� NS AND SPECIFICA-11ONS. OWNERPHONP�� � i1
Q LOT NO. Z
_F ' JOB ADDRESS _Z �/V� Sa _h40ME A ARCHITECTtr �-1
ENGINEER fj
ADDRESS _ �� _ DESIGNER
O REMODEL D_ ADDITION �UHEPAIR ❑AE_NEWAL ❑F;RE DAMAGE0DEMOLIT N
4—'!I NC..F I`'J "M LIEDUCATIONAL 0GOV'T ❑RELIGIOIISOPAT10 ❑CAR PORT RG,"kRAGE ❑STORAGE —SIAB (]FENCE
1,- ND OMOVING ❑CONDITIONAL USE ODLSIGN REVIEW OCOUNCIL APPROVED []SIGNS
;.tl'r,NCYNq D USE ZON '__._L--BLDG TYPF FIRE ZONE-._.-._. PIAN CHECK BY_ HEAT_ Cl
hO 1)671
IL
vt
J,, UAD _ FI. )QrJ4AD.__. ---r��'yt �4Q..,�QR.1f:�_
J
F+.III.FIING CJEPARTMENT SETBACKS_FRONT 3jREAR LEFT SIDE RIGHT SIM / Q
r'e I m I f -- — __ �J ----- - ------ -- - _.
—` THIS PERMIT IS ISSbrD SUBJECT TO THE REGULATIONS CONTAINED M THE BUILDING CODE, ZONING
'Ian Check REGULATIONS AND ALL APPLICABLE CODES AND OnDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PL AMS AND SPECIFICATIONS AND IN COMPLIANCE WITH
uh Inial _J dL' ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF TH"o PERMIT DOES NOT WAIVE
_ RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE. SEPARATE PF RMITS REQUIRED FOR SEWER, PI UMBING AND HEATING.
I c t a �� �...
APPI(CANT OR AG,EENT _
I,I,„ eIt Receipt No. 1p-t __ _L�-']�
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