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
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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)
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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-