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14195 SW 112TH AVENUE 14195 SW 112TH AVENUE ilk Y� ADDRESS //�2 PERMIT NO. - PERMIT CHARGE none OWNERr - - CONNECTION FEE .� �-4-V ._._.-.� PAID BY 'TYPE OF BUILDING .� ::i .i_ DATE CONNECTED INSPECTION FEE SERV ICE RATE CONTRACTOR PAID BY DATE _ SIZE OF CONNECTION 4 ' � —� ASSESSMENT PAID ___- I City of Tigard INSPECTION N RECDUEST S for IINSPECTION TIME : ILLL PERMIT NO. .' - DATE: O. : -.DATE: Z I -- DATE ISSUED: OWNERS NAME : CONTRACTOR :_ -- -- ITEST. Air 0, Water kf, VisualV', L.aboratory ❑ RESULT. Approved I;f , Disapproved ❑ Pending L3 SKETCH: �0" I Lae c �r I 1 INSPECTOR DATE LN0TI Attach supplemental toot dole csrstd I i. �) 1 I e� ZI � y r� �( �J �( .�I � � � � � �` _' ,�: � ��� :1, ��': � �- �► �� �� �. � �� `� �D w `a- �i I` d � I - V I f I