8616 SW SCOFFINS STREET 8616 SW SCOFFINS STREET
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PERMIT TO CONNECT
City of Tigard ,
Permita [7{'� ''11 �r
N. V�i DATE
e PRRMII' 10 GIVEN
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TO CONNECT Il ------
TO THE SYSTEM OP CITY OF TIG. iPn
AT
THIS PERMIT',' US7 BE POSTED ON THE DESCRIPFD PRZMISES UNTIL CON.
NECTION IS MADE AND INSPECTION OF CONNECT'.G.J HAS BEEN COMPLETED.
PERMIT FEE PAID $ _d Jt ____ -CITY OF TIGARD
1/0 040
CONNECTION INSPECTED AND APPROVED
Data - - Superintendent - ---
Permit No.
Name of Occuk ant _ _ Permit charge
—.--- -- --- -- - ---- -- - — Connection fee_p____
__ _ -- - ------------- Paid 1 9------
- _-- Date connected Type of Building -__ - _ inspection fee /Q
Service Rate Paid by - Dates
Contractor Assessment Paid
Size of ronnection
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