14860 SW 96TH AVENUE l�
14860 SW 96TH AVENUE _
cr
I
a�
C
N
L
1D
U7
O
0
00
City Uf Tigard
INSPECTION REQUEST
for
INSPECTION 'AIME' :_—PllA PERMIT NO.:
DATE: . 29- DATE ISSUED:--Y--
OWNERS NAME :
ADDRESS : �� � ��•--
CONTRACTOR :
TEST: Air [], Water, visualpf. Laboratory D
RESULT: Approved , Disapprived ❑ , Pending
SKETCH: Z. 77. _
I
/,�40
I
J
INSPECTOR DATE
[nTC Attach supplemental t..t data heft]
r ,
G� 566
ADD RE5SC Arrc'�L• �y7,�` . PERMIT N0.
PERMIT CHARGE none
OWNER i:::I� __, CONNECTION FEE ,'%7cc
._ PAID BY 7
TYPE OF BUILDING
_ DATE CONNECTED
SERVICE RATE , 1 ., �. INSPECTION FEE .:
r
CONTRACTOR PAID CiY ��:_. DATE 1
SIZE OF CONNF.LTION �// _ ASSESSMENT PAID
R
i