11620 SW 121ST AVENUE 11620 SW 121ST AVENUE
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PERMIT TO CONNECT
(City of Tigard
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Permit NO SUU DATE
PERMIT IS GIVEN TO__`_
TO CONNECT A
TO TILE SYSTEM OF CITY OF TIGARD
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ CITY OF TIGARD
CONNECTION INSPECTED AND APPROVED
$ c,►, cRi i d
Data —� "_ . -Superintendent _— _
r
Address Permit
Name of Occupant .__ Permit charge
Connection fee_ —
?aid by-- --- _—
Date connected 7-Z f
Type of Building —____ Inspection fee_ _.
1
Service Rate_ ___.-�_--------_--.-_ Paid by Date_._
Contractor -___- . .. __-- Assessment___-_-
Size of connection _ ___