12350 SW KATHERINE STREET 1.2350 SW KATHERINE STREET
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City of Tigard
INSPECTION REQUEST
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!NSPECTION TIME :_ � � PERMIT
DATE : DA"r ISSUED.
OWNERS NAME ' / ikl
ADDRESS :
CONTRACTOR
TEST. Air r'], Water El , Visual Laboratory []
RESULT: ApprovedDisc,pproved 0 Pending []
SKETCH:
1
INSPF ' " I DATE
NOTE : Attach supplemental test data �ett�
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FEE ;,�`� DATELOC
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MECHANICAL A PERMIT
DATE BY DATE By
EXCAVATION/FILL AIR CONDITIOP1ING
_ d FOOTINGS/FOUNDATION VENTILATION
FORMS � SPRINKLER SYSTEM
_._ SLABS - MASONRY FLUES
R QRCIP,G STEEL F
P?FIRE-DOQRS EXITS
STRUCTURAL STEEL - GARAGE - _--
FLOOR
PLUMBING-R , I . DRIVEWAY
jRAI
'r' FLASHING SEWERE STORM DRAINTH/WALLBOARD PARKING
HEATING _ ~�
REE
- -- WATER HEATER FINAL -..__.._...__.___•_--- - ._____.._. _ ...
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ADDRESS I PERMIT NO.
PERMIT CHARGE
OWNER I`.� �v.�� t 41 CONNECTION FEES
PAID BY
TYPE OF BUILDING �� � � �w�c DATE CONNECTED
SERVICE RATE. �� ;�, , ,�x �: _,��,_� INSPECTION FEE
CONTRACTOR PAID BY �;���_i DATE _
SIZE OF CONNECTION `� _ ASSESSMENT PAID