11620 SW BURLCREST DRIVE-1 .fir' � �� -. r•••' ,' �_ _ .,� �.. � N �� I_ �c -1
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11,620 SW
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BURLCREST DRlVE
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Name of Occup,,nt__ _ Permit charge A__ "
Connection fee 2 i 4
P�,d by --- -- ----- - --
Date connected 11 - 2- 1
Type of Building _ Inspection fee
Service Rate_ ____Date_
Contractor _ Assessme at Paid
Size of connection '
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PERMIT TO CONNECT
City of Tigard
loormit N?. 698 DATE.. 1! c l L."�0
PERMIT IS GIVEN TO
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TO CONNECT A.---.,
TO THE SYSTEM OF CITY OF TIGARD
THIS PERMIT MUST BE Pn'T,-" ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE ANI. INSPECTION OF CONNECTION HAS BEEN COMPLETED. 1
PERMIT FEE PAID CITY OF TIGARD
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CONNECTION INSPEC'T'ED AND APPROVED
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