11870 SW BURLCREST DRIVE O
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118'/0 SW BURLCREST DRIVE
Address Permit No.
Name of Occupant _ Permit charge .2 —
Connection fee 1,5 O
Paid by_
Date connected 7
Type of Building Inspection fee 10
Service Rate_ _ Paid by --__ Date
Contractor Assessment------Paid
Size of connection_-�_____
PERMIT TO CONNECT
R'-ity of Tigard
Permit N° S 5 O DATE_.__l_/L
PERMIT IS GIVEN TO __—L.!�li �SJL/�' / ✓/ �`
OF /' 1C ' n5 IV
rO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD v 3
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID =._ ` ' )—.---CITY OF TIGARD
CONNECTION INSPECTED AND APPROVED
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