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CITY OF TIGARD BUILDING DIVISION PERMIT #: C( cr.S poyZe_ 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: //fr / Phone: (503) 639 -4171 j�l�� Inspection Requests (24 Hrs.): (503) 639 -4175 °_- INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /7 /'f 5t / SuMM C r bg, CLASS OF WORK: SUBDIVISION: Q/„tj„tair..._ , it_S pile< LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Ic /cam Pour Time: Code # Inspection Description Confirm # Contact # Message !9 cz-r. Corrections /Comments/ Instructions: La ti✓ V o LTA -, 41 v J PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C,4 -rte Date: ICVZ-S Phone #: (503) 718- ZK4l y