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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: �%^fi PERMIT NO. :_
GATE : . //7/74, DATE ISSUED .- .LL_ i
OWNFRS NAME : w,
ADDRESS: _._. 93YO._.�'�.T..r�___� ._
CONTRACTOR : G.
TEST : Air G, Woter/kj , Visudc ❑ , Laborotory ❑
RESULT' ApprovedO . Disapproved ❑ pending [a
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'3PE:CTOR DATE