11810 SW 79TH AVENUE-1 i
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PERMIT T4 CONNECT
City of Tigard
Permit N? 888 DATE_
PERMIT 3S GIVEN
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TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD1.� �j
AT /_0
THIS PERMIT MUST BS POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ CITY CF TIGARD
CONNECTION INSPECTED AND APPROVED
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Date Superintendent
Address "t l 6 S1L1 7 ! t4 _ Permit No. Er
Name of Occupant Permit charge C/C -!7• G G
Connection fee
-- --- Y___-_—
-- . _._---- - -- _ aid b
_ --- ---- - Date connected
Type of Building__ - Inspection fee
ServiceRate
------- -----
aid by . . .__.---__----
Contractor Assessment Paid
Size of connection
Address 1/57 3s sc�(,) 7 / Z4 Permit No.
Name of Occupant_ Permit charge Z_tw-- �/O• d�' �'V
Connection fee
-- _- _ -- Paid by.---- —-
Date connected
Type of Building - --___ _ Inspection fee
Service Rate _ Paid by Date
Contractor -- Assessment_ - Paid
Size of connection