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Permit Support Document CITY OF TIGARD BUILDING DIVISION PERMIT #: 1''l I: ! 114 -()Oa'`' I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 Aft, , �,,i, Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: \ _ t c_'• _, Sq TIME: PAGE: SITE ADDRESS: t } ',D':;',13 -„CO, t9% . c y,i r t. CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: —r-; ,a,,,, ,, . C'sc,, i ' 't ""1 DESCRIPTION: ~- OWNER: PHONE #: CONTRACTOR: 5 PHONE #: Inspection Request Scheduled For: Date: 1 - ! (1)- .) k(}.- Pour Time: Code # Inspection Description Confirm # Contact # Message ..`:' ti '1 {. c-,.7 - 7r)2' ,':S4q Corrections/Comments/Instructions: ( ) c'. r t=t , -1 ,v yL , * I -A (4JL\ krr \ C . ,, --� r .�k .. x_16 PASS ❑ PARTIAL APPROVAL ❑ CANCEL [l NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i.)c., > . Date: ; -- f ‘ .14,- Phone #: (503) 718-