11725 SW 95TH AVENUE _�. 11725 SW 95TH AVENUE
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PEPMIT TO CONNECT
City of Tigard
Permit No 13 DATE-
PERMIT IS GIVEN TO -W/-difii-- i.rs..'CL ----- - -- --- -
OF
TO CONNECT A-4 ----
TO THE SYSTEM OF CITY OF TIGARD
AT _._L��� ti S_Sd1_.. ftF1I�. C -
THIS PERMIT MUST BE POSTED ON THE DHSCRIBED PREMISES UNTIL CON
NECTION I5 MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ :' CITY OF TIGA�
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CONNECTION INSPECTED AND APPROVED
Date - Superintendent
Address /���' S.G�� Permit No.
Name of Occupant ! //��f ,q L/L�/s�(f" Permit charge
Connection fee
---- - - --- Paid b
_ Date connected
All
Type of Building E.SiI�F Inspection fee _ ✓ �'
415 17
/
Service Rate �° - _ - — Paid by _mo w, -� Date 1",21'/
Contractor. Assessment. r—Paid
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Size of connection ,_