12115 SW 92ND AVENUE 12115 3W 92ND AVENUE --
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Date Requested "" �� Time— A.M. P.M.
Address ! `> u -z- Permit #__....
Owner_ �3:• i�`x��<'�K Lot #
Builder _ ��� , ------- ------
The f0owing Building Code deficiencies are required to be corrected:
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Presented to _ — — �---- ` A�-----+
Inspector U Dissoprov-A
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Date -- —�--.—
CALL FOR RFUNSP,r;CTlON
F1 YES l_a NO
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Address _2_l_L_� Permit No..
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Name of Occupant 0 Permit charge-.
Connection fee_ Z
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Paid by__
Date connected
Type of BuildingInspection fee
Service Rate i t'� Paid by __ _ _ Date_
Contractor Assessment_ a Paid
SizA of connection
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