11625 SW BURLCREST DRIVE-1 4
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard. Oregon 97223
Phone: 639-4175
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Type of inspection
Date Requested _ _III Time_ A.M. �__..-_P.M.
Addres- 11_ e ,�7 L� ___ Permit
Owner - _--__ �_____ Lot #
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I he following Buildiig Corse def.. .*.,.ies are required to be corrected:
Presented to _ �. __ _� [ 'Approved
Inspector _ ______.� [_� Disapproved
nate
CALL FOR REINSPECTION
C� YES O NO
Aadre��6�,�.���B�te[tt,ees T /�M- Pezmft x�. ?I, _
Name of Occupant__—__ Permit charge
-------------..___ ___ Connection fee
_._--- -- Paid by----
-- - - --- ---- --_- Data connected -
Type of Building_ Inspection fee
Service Rate Paid .by - Date
Contractor Aac�se�ment___ Paid
Size of connection