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City of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME :,-L- 166 PERMIT NO. : -
DATE:
O. : ___.DATE: ..,Y��//�' DATE ISSUED:_.
OWNERS NAME :ADDRESS : -
CONTRACTOR :
DDRESS :CONTRACTOR : .
TEST. Air 0, Water ❑ , Visual ❑ , Laboratory ❑
RESULT: Approved, Disapproved ❑ , Pen�;nn r]
SKETCH:
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I SP OR DATE
ICOTE : At tor', iuppis rrental tort data heret]
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