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Permit CITY OF TIGARD BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 � a , i � l h — r r Inspection Requests (24 Hrs.): (503) 639 -417 ,l 6 .r1 L' INSPECTION WORKSHEET FOR DATE: TIM PAGE: SITE ADDRESS: L2 ��4, CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: retuderS 1 OWNER: FI 19k4 0 yvvipt fa S PHONE #: 59'. - 4 /4 . 3 - 3 0 CONTRACTOR: PHONE #: 5- 3 �� 2 _ 3 c � / In 3 e I ( (vt�ti) moo Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: '��) J _ ' ‘ ,e, O '-- J Il/7 PASS ❑ PARTIAL APPROVAL ❑ CANCEL . ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED L 1 Inspector: �e Lt 4 1) . ! Date: � - Ob Phone #: (503) 718-