Report (16) STREET TREE
TIGARD
CER TIFICA TION
1, �K --74P-7X7 , owner/agent or WO( 1G'���g f
(PLEASE PRINT) (PERMIT HOLDER)
do hereby cert that the following location meets
City of Tigard land use and development standards
for street tree installation and is consistent
with the approved site plan.
PERMIT NO.: I'I -GYiO%
.S'ITE ADDRESS: /1/&90 St.(,' !17 MA Or . ci7P ff
SUBDIVISION: LOT #:
SIGNATURE: DA 1E: /I f i;/ks
OII"NER/AGENT)
RECEIVED &
VERIFIED BY: DA I IJ:
(LY" -OF TTGA / 4. !s'E
j/t7:5
Tree location verified per approved site plan. 4' /09,P‘/S,
I:\Building\Forms\Strcct rrccCcrti6catc 05/30/2012