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13260 SW ASH AVENUE
Address_ %-3 � �� �4ft;=df Permit No. e12
Name of Occupant __.- Permit charge -
Connection fee �'�'� ee)
Paid by _, Z(li-
- - -- -------- - ..__. -- Date connected- --��
Type of building ''t � 'Z�e�'�t= Inspection fee__.___
Service Rate__ �a'�C'� _ Paid by,rlC c 4-elle' Date�s�
Contractor. 1 ,!�r/ %,C - �-_ Assessmeut_ __Paid
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PERMIT TO CONNECT'
City of Tigard
Permit N? 9 DATE--rae44�� _
PERMIT IS GIVEN TO
OF Ito /,/c
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
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THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL COW
NECTION 19 MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FBI PAID _CITY OF TIGARD
By
CONNECTION INSPECTED AND APPROVED
DNe Super;"endent