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9555 SW MURDCx'K STREET
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City of Tigard
INSPECTION (REQUEST
for
INSPECTION TIME: -- ------�,� ?ERMIT NO. :
DATE: ����-LLQ'—BATE ISSUED :--J--2— i
OWNERS NAME ' --n C-Y s -- !
ADDRESS. -55
CONTRACTOR '
TE ST : Air Fl, Water 0 , Visual p , Laboratory p
RESULT Approved,^, Disapproved 13 Pendi L7
SKETCH: I
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P E R M I T N 0
A D D R E 5 5
PERMIT CHARGE none
.._..----....__.._.l�-- --_�-__ .....__..ti_. �` CONNECTION FEE'
OWNER
PAID
DATE C0NNELTED
TYPE OF BUILDING
51ptvI(-,E RATE INSPECTION FEE --------
PAID BY DATE
CONTRACTOR ASSES 5M.ENT PAID
SIZE OF CONNECTION