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DRAWING IS LESS CLEAR MAN
THIS NOT ICExi-IT IS DUE TO
THF QUALITY OF THF ORIGINAL
001"DRAWING.
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10515 SW CLYDESDALE PLACE
7 �6 _ y �
ADDRESS
PERMIT N 0.
PERMIT CHARGE
OWNER t, ll.�,t.� ;t� .' CONNECTION FEE
PAID BY
TYPE OF BUILDING `��,,,yi��,�. DATE CONNECTED
SERVICE RATE �> � -� INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION 4' _ __ ___ ASSESSMENT PAID
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City of Tigard
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for
1Nz`)-PECTION TIMEOWN r
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RESULT' ° :`iSapprc j—1 1 :r 3
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City of Tigard
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INSPECTION REOUEST
for
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INSPECTION TIME : • PERMIT NO.:
DATE: DATES ISSUED:
OWNERS NAME : ��'5( /-
I ADDRESS :
CONTRACTOR
TEST: Air p, Water p , Vieual)t(, Laboratory p
RESULT: Approvedk, Disapproved 0 , Pending p
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I SKETCH:
job 1
� DoT
57-VE? ori 76x-
low` 61Cl -
I INSPECTOR DATE
ICOTE : Attach supplementol test date heret-10
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