HomeMy WebLinkAboutCALLOW AVE. N., 343
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BREMER TON PERMXT CENTER
286 4th Streetg Bremerton~ ~A 98337
Phone:; (360) 478-5275 FAX g (360) 478-5278
BUILDING PERMIT
Job Addr: 343 N CALLOW AVE
Location:
Pa:rc:el No:
Applicant: JACKLEY, BROCK 377-0391
343 N CALLOW AVE BREMERTON WA 98312
Permit No: 99-0518
Status: READY
Applied: 09/16/1999
Issued:
Expires:
Owner: JACKLEY, BROCK 377-0391
343 N CALLOW AVE BREMERTON WA 98312
:ontractor: SELF
L.:lc i~: SE1..F Exp:
Subc:cmt r :
)esc: ADD 2 NEW WINDOWS TO THE STORE FRONT
~****~~***************************************************************************************
Valuation * Permit Fees: 23.70 Total Calculated Fee: 43.61
650.00 * Plan Check Fees: 15.41 Additional Fees: .00
* Other Fees: 4.50 Total Permit Fee: 43.61
*********************************************************************************************
rhis permit shall become null and void if the building or work authorized by this permit is not commenced within
180 days from the date of such permit, or if this building or work authorized by such permit is suspended or
~bandoned at any time after the work is commenced for a period of 180 days.
~OTICE - It is the responsibility of the permit holder, not the City of Bremerton or Building Official to see
~o it that required inspections are made. The permit holder must notify the Building Official when ready for
inspections. Failure of the permit holder to notify the Building Official of required inspections may result
in the stoppage of the work until such time that the permit holder can substantiate to the building official
that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall
)e borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City
Jgainst any and all responsibility or liability connected with the construction.
[ hereby certify that I have read and examined this permit and know the same to be true and correct. All
)rovisions of laws and ordinances governing this type of work will be complied with whether specified herein
)r not. The gra ing ofa~per~it does not presume to give authority to violate or oancel the provisions of
~ny other tat or local~?w re~~lating construction or the performance ~f construction.
5ignature=__ _ ____~__~-~ ______~______________ Date:__~~_~~___!___~_________
r certify t, at I a: exempt ~eqUirements of the state contractor's registration law, under
Sect ion 3/ Chapter 1'26, 1 aW$ of 1967.
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;ignature:_ ~_~___~________________~~__________________ Oate:_____________________________.__
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'oroit Gent er--Approved By: -tf'Jc:1-.-.:. Oat e : ............. I.. ...~-..L...l q 5
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BR~MERuaN PERMXT CENTER
286 4th Street g Bremartong bolA 98337
Phone:: (360) 478-5275 FAX:: (360) 478-5278
Job Addre?s:843 N CAllOW AVE
Locat :1. (in ::
Cl,f,;HH' Acc;t N(:l:i
Building Permit No: 99-0518
St at UE~ = 1:~l::::ADY
:r f:.~sued::
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l:~ E (;;J U I F~ I:::: D
INS P E C T I 0 N.S
Item: 02700 FINAl--BLDG
Dept:: BL..DG
D:I. v:1. B i on =
**********************************~***********************************************
TESTING: Must be iecognized by the Washington Association of Building Officials
3PECINSP: Must be registered with the State of WA
3T OF WA= State of WA Dept. of labor and Industries 478-4921
~EALTH:Bremerton/Kitsap Health District 478-5285
~lL INSPECTIONS PERFORMED BY THE CITY OF BREMERTON MUST BE SCHEDULED THROUGH THE "
;) F'I:~ M T ''I'' (" F' N ''I'' F:' R ( '36 (')) 4. 7n... I;;' ":'''1 I:;'. .~.
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BROCK JACKLEY I
343 NORTH CALLOW \ 1/
BREMERTON, WA V
WINDOWS 1
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BREMERTON PERMIT CENTER
286 4th Street, Bremerton, WA 98337
Phone: (360) 478-5275 FAX: (360) 478-5278
BUILDING PERMIT
Job Addr: 343 N CALLOW AVE
/ ,
L:ocatlon:
Parcel No:
Applicant: JACKLEY~ BROCK 377-0391
343 N CALLOW AVE BREMERTON WA 98312
Permit No: 99-0518
Status: PENDING
Applied: 09/16/1999
I s!3ued :
Expires:
Owner: JACKLEY~ BROCK 377-0391
343 N CALLOW AVE BREMERTON WA 98312
Contractor: SELF
Lic n: SELF Exp:
Subcontr:
Desc: ADD 2 NEW WINDOWS TO THE STORE FRONT
*********************************************************************************************
Valuation * Permit Fees: 23.70 Total Calculated Fee: 43.61
650.00 * Plan Check Fees: 15.41 Additional Fees: .00
* Other Fees: 4.50 Total Permit Fee: 43.61
*********************************************************************************************
rhis permit shall become null and void if the building or work authorized by this permit is not commenced within
180 days from the date of such permit, or if this building or work authorized by such permit is suspended or
]bandoned at any time after the work is commenced for a period of 180 days.
~OTICE - It is the responsibility of the permit holder, not the City of Bremerton or Building Official to see
to it that required inspections are made. The permit holder must notify the Building Official when ready for
inspections. Failure of the permit holder to notify the Building Official of required inspections may result
in the stoppage of the work until such time that the permit holder can substantiate to the building official
that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall
)e borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City
]gainst any and all responsibility or liability connected with the construction.
[ hereby certify that I have read and examined this permit and know the same to be true and correct. All
)rovisions of laws and ordinances governing this type of work will be complied with whether specified herein
)r not. The granting of a permit does not presume to give authority to violate or cancel the provisions of
iny other state or local law regulating construction or the performance of construction.
iignature:__________________________________________________
Date:
[ certify that I am exempt from the requirements of the state contractor's registration law, under
iection 3, Chapter 126, laws of 1967.
iignature:__________________________________________________
Date:
~**************************
)ermit Center--Approved By:_______________
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PERMIT CENTER
286 Fourth Street, Bremerton W A 98337
Phone: (360)478-5275 Fax: (360)478-5278
Building Department
REQ~D I fl\fSPECTION TYPE
! Foundation Footin
I Foundation walls
Electrical
I :vfechanical
I Plumbin Groundwork
. Plumbin Rou h-In
I Framing
Insulation
Sheetrock/ nailin
I Other:
I Final
Special Inspections
REQ~D ! Il'';SPECTION TYPE
I Soils, compaction
! Concrete Strength
I Welding
I Other:
J.Von-Residential Enerl!Y Code*
I Slab / undertloor insulation
I Wall insulation
I Ceiling/roof insulation
_-\ir leakage
Glazing
Ligh ring Budget
c\fechanical Venting Systems
HVAC
:vfotor Efficiencv
Other:
Fire Department
REQ~D INSPECTION TYPE
Fire Sprinklers
Fire .-\larm System
Other
Final i
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Public Works
I REQ~D INSPECTION TYPE ;
Erosion Control I
Public right-of Way
Sewer Lateral
Irrigation systems i
Cross Connection I
Other: ,
Final I
!
PIannin
· Inspections to be performed by WSEC Certified Special Inspectors recognized by WABO
and registered \vith State Labor and Industries.
........;...
.....................B.ullCJ.tn.g......I>.etml1i.....~ppUc.a1:1011. .......................................................................
.~t)3*~a4~ti4WA.9gjJ']'Ph()d~:~6{) .418..5Z7$f~~ .360 47S.Usd,s H <... ..
q~~ 05{g
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Tax Account Number=3. 7 '=5 :3-
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....... ............
...........Ci..
APPLICANT: DOWNER DCONTRACTOR DOlliER
Site Address:
L-n t.
o.vnei:u74i{~2J~<>
Contractor:
C::-
Address:
Contractor License #:
Expiration Date:
/
Check the type of application applied for below: m?D IE (il) re n ~8 ~ j~-D'
o SFR 0 DUPLEX 0 NruLTI-FAMILY .", [lry Is U \;i h" ,
~ .
o J\;IOBILE 0 ACCESSORY BLDG 0 RES ADDN BEl' 1 6 1999 \.
o RES RENI 0 CONIM ADDN 0 COMNI REM
o REPAIR 0 SIGN 0 DENIOLITION BREMER'TON
o NEW COMM. 0 TENANT IMPROVEMENT BUILDING DEPARTMENT
o GRADING (cubic yards: ) 0 OTHER:
Nature of Work Proposed: ;tJ J d
,;2
~ y (q
Lv / () [) 0 t,I..i j
Square Footage: Dwelling
Garage:
Decks
............. .........~~}R~\I'i.~w..lff~~(. .\....Pefifiit..F~~ \ ...(......$tii~~t.....tfS
. c::.. 4-! gnp~Q" ~~() ()()
I J '" State: $ 4.50
Applications for which no permit is issued within 180 days following the date of application shall expire by
limitation, and plans and other data submitted for review may thereafter be returned to the applicant or
destroyed by the building official. The building official may extend the time for action by the applicant for a
period not exceeding 180 days on request by the application showing that circumstances beyond the control
of the applicant have prevented action from being taken. No application shall be extended more than once.
In order to renew action on. an application e iration, the applicant shall resubmit plans and pay a new
I . c '.
p an reView [ee. "'"
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APPLICANT'S SIGNATURE~ DATE: 9--/~ - ~
. . OF 81/
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CITY OF BREMERTON
Non-Residential Building Permit Checklist
Applicant:
BUildingpermit#:qC; r OS! 8
ver Sheet (w/occupancy & type of const)
Scope of Work
Completed Application
Bid or Floor Area Breakdown
Floor Plan
ra ing Plan (cross-section)
Elevations
Foundation Plan
Barrier Free Compliance
~ ArchitecturallEngineered Drawings
Street & Utility Permits required
Mechanical Plan
NREC Stamp/Compliance
_ Lighting
Mechanical
_ Envelope
D Erosion Control Plan
D WSVIAQ Compliance
Comments:
Date:
Site Plan (dimensioned)
Zoning District Indicated
Contractor Verification
Landscaping
Parking Plan
SEP A Checklist (if applicable)
Site Plan Review Questionnaire
Vicinity Map
Special Land Use Condi' s re [I \\ r-.",
. Or Permits ! D ~ ... Ie \~n ~ tDII
~ Sign Permit Applicable \' '-, ,--. ~ ' .., 1'-, ~ !J
Plumbing Plan qr::, 1 t~ 'l\~("() ..
. \, l,.. I \.l 'oJ \J "..J
Cross Connection
Fire Department Info 8REMERTON
_Alarm System BUILDING DEPARTMENT
_ Sprinkler System
D Storm Drainage Plan
D Health Department Approval
C:\My Documents\Commerical Chccklist.doc
Last printed 01126199 9::15 AM
Scope of work:
Address:
Owner:
Contractor:
BREMERTON BUILDING DEPARTMENT
Inspection Report
Permit Number: Of q ,.-- () 5/ ?'
Phone: .3 77- C)~==S c:p /
Phone:
Inspection card/approved plans on site Setbacks .
Footings required steel placement Walls: required steel placement
Footings: required width & depth Walls: required size
_.. Special inspector (when applicable)
Bearing soil (soils analysis if applicable)
FOUNDATION
COMMENTS:
FOOTINGS APPROVED:
WALLS APPROVED:
Electrical approved Plumbing & mechanical approved
Crawl space access (min, 18 X 24) Floor joists and beams/proper clearance to earth
Positive connections posts & beams Foundation vents
Posts properly supported Anchor bolts: nuts & washers in place
Mudsill treated material Floor joists: size & spen
Beams/girders: size & span Notching & drilling: joists & beams, studs
Smoke detectors: all required locations Exhaust fans: where required
Exhaust fans insulated: unconditioned space Whole house fan, outside air intakes each bedroom
Fans terminating directly outisde Range hood
Dryer exhaust vent All vent terminations: windows & property line
Fireplace combustion air Windows: meets egress requirements
-
Windows: proper U valve Windows: safety glazed where required
Ceiling heights Stairs: headroom clearance
Stairs rise & run; proper width Fireblocking: wall to ceiling, furred walls every 10'
Fire blocking; stairs, soffits, lowered ceilings - Fire blocking: tubs/showers
Fire blocking lids in void spaces, shafts Fire blocking: stuff holes top & bottom plates
Sheetrock backing Wall bracing
Rafters size/notching Trusses: specs, bracing
Attic access Attic ventilation
Wall & roof sheathing Shear nailing
Building dried in
FRAMING
COMMENTS:
APPROVED:
Insulation: proper R value Insulation: proper fastening
Insulation: vapor barrier Bottom plates caulked to floors
Penetrations caulked as required Electrical boxes gasketed or caulked
6 mil black poly in crawl space
ENERGY CODE COMPLIANCE
COMMENTS:
UNDER FLOOR/FOUNDATION INSULA liON APPROVED:
WALL INSULATION APPROVED:
CEILING INSULA liON APPROVED:
- Appliance clearance to cornbus!ibles
Appliance location and access, proper support
Venting clearance to combustibles Venting: size & support
-- Vent termination Combustion air
--_. ----
Ducts: size & support , Gas pipe under test
Gas pipe size & support Gas pipe: underground min. 12" below grade
Gas pipe within 6" or underground-coated - Gas shutoff within 3' of appliance
Gas logs safety shut-off Gas logs damper permanently open
.-- --. ------ ---------~-----
Wood stoves EPA certified Wood stoves & fireplaces: Tight-fitting doors
-- .--
Woodstoves & fireplaces proper hearlh Manufacturer's specs on sitE)
--. -
Chimney liner when required Chimney: separale flues when required
MECHANICAL
COMMENTS:
GAS PIPING APPROVED:
FURNACE APPROVED:
OTHER APPLIANCES APPROVED:
PLUMBING
DWV & water piping under test DWV: proper grade
DWV: proper sizing u__ DWV: proper drainage fittings where required
---
DWV & water piping proper support DWV required c1eanouts
..-- --- -
Vent termination All fixtures vented properly
-- .---
Waler supply proper sizing Shut-off valves on all fixtures
--- --C-:-C-.-- _ --- ._-- --
Water healer gate valve on cold water supply Vacuum breakers: where required
-~------- --------~_._--------------_." ------_.. ----
Water heater relief valve drain to outside Water heater: siesmic strap
-- ..- ...------. ._~-
R-10 pad under water heater when required Water-piping insulated as required
..--
Grease traps/interceptors: where required Ploper indirect wastes where required
COMMENTS:
PLUMBING GROUNDWORK APPROVED:
PLUMBING ROUGH-IN APPROVED
SHEETROCK
-
Proper fastening: nails-?" oc. horiz plane nails 8" o.c. vertical plane
--- --- --
Proper faGtening. screws.12" o.c. horiz. plane (1/2") screws.12" o.c horiz. plane (1/2") 24" o.c. framing
.-.--__.0-
Proper fastening screws-16' o.c. vert plane (112") screws-12" oc. vert. plane (1/2") - 24" o.c. framing
_._-~-- ----.-- ._.
Proper fastening screws-12" oc. horiz plane (5/8") screws-12" o.c. horiz. plane (5/8") - 24" oc framing
--.. . .-"-.------- -
Proper fastening: screws- 16" o.c vert plane (5/8") screws-12" oc. verI plane (5/8") - 24" o.c. framing
--.---- ----- --------- --
Area & occupancy separation walls Draftstops where required
---------- . ---- -----.--. --- -.
Usable space under stairs (5/8" required) Waterboard where required (not on ceiling)
.-- --- ----....-.- -------
Corridors
COMMENTS:
SHEETROCK APPROVED:
FINAL
Energy code requirements met, exhaust fans Plumbing & mechanical
-- --" -------, - --.
Garage/dwelling door self closing solid core Smoke detectors where required
.------ --'-- - .._~- ---------- -------,-------"---- -.----.-------
Handrails & guardrails, as required Fire ratings maintained
-'-, . -- --_. ,---
Exit signs when required Emergency lighting when required
--
Occupant load posted when app!icable Building weathertight
--.-----
Wood siding to earth separation (6" Building Address posted
------ Radon monitor when required
COMMENTS:
FINAL APPROVED:
~
/ -_~'8~ 06
. .~~:
BUILDING: .(7'8..5281
TO: [Building J
Business License
Traffic
Cityof BremertOIt
DEP.-\..RT~{E~T OF CONSTRUCfION
A.J.'1D LA...'\Tl USE
PLANNING: .r78-.5!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering
r"ire
H'ealtf\. Dept.
Water/Wastewater
Planning
Please review this request for approval to occupy the following structure and
return to chis department by 4/20/93 thank you.
Date:
4/7/93
Permit Technician: Janet Lunceford
* * * * *. itl/ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * .
Type of Occupancy B2
Occupant Load 67
-'
* * * * * * * * * * * * * * * * * * * * * * * * . . . . * . * . * * * * * * * * * * * ,
Name of Building
Name of Tenant
(if applicable)
Owner of Building
~ature of Construction
(i'f applicable)
Address
Contractor
Pennit IJ
Penilt Date
Type of Construction
Square feet
Use
Comments:
Dave's Loans and Guns
same
. unknown
interior tenant remodel
343 N. Callow
Splf
13657
8/6/92
\TN
4307.
Retail
Approved
/Disapproved l:7 By:
Date: i-,J 1/9~
.
817 P."CTFlC ,l,V1::-lt.:c: . BR.=:~ERTON. WASHINGTON 98)10
BUILDING: .f78-S28t
TO: ~'lding ~
Business License
Traffic
Cityof BremertOIt
DEP.-\.RT~IE~T OF CONSTRUCTION
..-L'lD L..-L'\TI USE
PLANNING: .f78-SZ7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering
\f "... J. 1. -. .:>
,~~V.'--"""""
. ire /; .
Water/Yastewater
''Pi'anning ~
./
lfealtn. Dept,
Please review this request for approval to occupy the following structure and
return co chis department by 4/20/93 Thank you.
Permit Technician: Janet Lunceford
Date:
4/7/93
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ~
Name of Building
Name of Tenanc
(if applicable)
Owner of Building
Nature of Construction
(i'f applicable)
Address
Contractor
Permit II
Per:nit Date
Type of Construction
Square feet
Use
Type of Occupancy
Dave's Loans and Guns
same
. unknown
interior tenant remodel
343 N. Callow
Self
13657
8/6/92
VN
4307 .
Retail
B2
Occupant Load 67
-.
* * * * * * * * * * * * * * * * * * * * * * * * * * * . * * * * * * . * * * * * * * * ,
Comments:
Approved L:7 /Disapproved L:7 By:
Date:
817 P....CTFTC AVENVE . BR.E~ER1'ON. WASHINGTON 98:110
BUILDING: .f7S-,5281
TO: Building
Business License
Traffic
Cityof Bremer:tOI1/~
Cf3
DEPA.RT~rENT OF CONSTRUCTION '
A..'lD LA....'\~ USE
PL..ANNlNG: .f7S-,5!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering
r~ire
lfealtn Depc,
Water/Wastewater
lPlanning3
Please review this request for approval to occupy the following structure and
return to this department by 4/20/93 thank you.
Date:
4/7 /93
Permit Technician: Janet Lunceford
* * * * *.~ ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * i
Type of Occupancy HZ
Occupant Load 67
-'
R . * R . * * . . . . * . * * * * * * R R * . . * * * * . * * * * * * . * * * . . * . )
Name of Building
Name of Tenant
(if applicable)
Owner of Building
~ature of Construction
(i'f applicable)
Address
Contractor
Pendt IJ
Per:nit Date
Type of Construction
Square feet
Use
Commencs:
Dave's Loans and Guns
same
. unknown
interior tenant remodel
343 N. Callow
Sf'.] f
13657
8/6/92
'vN
4307.
Retail
Approved ~ IDisapproved l:7 By:
Date:
.
817 P...CTFlC ..s,VE~t.:C: . B~~ERTON. WASHINGTON 98:310
BUILDING: .f7'8.S281
TO: Building
Business License
Traffic
Cityof BremertOrt
DEPART~rE~T OF CONSTRUCTION
A..'1D LA....'\"D USE
PL.ANNtNG: .m-S:!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering
t}'~ire f
l1e.altn. Dept,
Water/Wastewater
Planning
Please review this request for approval to occupy the following structure and
return to chis department by 4/20/93 rhank you.
Date:
4/7/93
Permit Technician: Janet Lunceford
· · · · ** * * * * * * * * * * * * * * * * * * · * . * * * * * * * * * * * * * * * * i
Type of Occupancy B2
Occupant Load 67
-'
* * * * * * * * * * . * * * * * * * * * * * * * * * * * * * * * * * . . * * * * * . * ,
Name of Building
Name of Tenant
(if applicable)
Owner of Building
~ature of Construction
(if applicable)
Address
Contractor
Permit IJ
Pen!t Date
Type of Construction
Square feet
Use
Comments:
Dave's Loans and Guns
same
. unknown
interior tenant remodel
343 N. Callow
Sf'lf
13657
8/6/92
VN
4307 .
Retail
Approved ~ /Disapproved L:7 BY:~~~L;i___
Da t e: S/- /3 J C;..3
.
811 P...CTFtC .-\VENt.:"C: . B~~ERTON. WASHINGTON 98:310
. <
FILE COMMENTS
,,<
SITE ADDRESS: APP.NO. Cl:J ffPDSlfio3
OWN~R: NO. PLANS 3
TYPE OF CONSTRUCTION SQ. FTG. OCC. LOAD
VALUATION PLAN CK. BLDG. SRCHG.
FEES PAID: PLBG. MECH. OTHER
."'.;"
DATE DATE APP. WI NOT
ROUTING: SET # SENT RETURNED APP. COMMENTS APP. REVIEWER
BUILDING ff'
PLANNING 0
DNTN PLANNING D
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TRAFFIC
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B REM E R TON
B U I L DIN G
D E P A ~ T MEN T
PER M I T
---------------------------------------------------------------------
----------------------------------------------------------------------
Application Date
Issue Date
Assessor Acct #:
Site Location
Owner - Last Name
- Street
- City
- Phone
Tenant's Name
Agent's Name
Architect's Name
[X] Building
[ ] Nechanical
[ J Plumbing
07/15/1992
08/06/1992
Application Number 92AP05463
Permit Number 13657
Project Group
343 N. CALLOW
JACKLEY
343 N. CALLOW
BREMER TON
(206) 377-0.391
First BROCK
1VH
state WA Zip 98310
Phone(206)
Phone(206)
[ ] Grading
[ ] Move Building
[ ] Nobile Horne
[ ] Sign
[ ] Burning
r. ] Land Clear
[ ] Paving
[ ] Underground
[ ] Demolition
Building Contractor:
-----------------------_._-~------------------------------------------
Work will be completed by owner.
Nature of Work:
Interior remodel to create retail and storage space.
Building Valuation
I
I
$3000.00
Council Dj.strict
---------------------------------------------------------------------
Census Tract
Construction
Type
7
Sq Feet
Inspections
Required
Residence [ ] Zoning Foundation [ ]
Business [X] Type Framing [X]
Other [ ] Insulation [ ]
New [ ] Plumbing []
Repair [] Status Mechanical [ ]
Remodel [X] Code Wallboard [X]
Addition [] 12 Final [X]
::::~ ::~ ~: ~ ~ L5~rz ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ :::~~::~ ~:~ ~ - ~ - ~ --~ ~ ~ ~ ~ ~ - - ~ - - - - ~ ~
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================================================~====================
r
Application Number 92AP05463 i
Permit Number 13657 J
-----------------------------------------------,---------------------
Building--approved as revised on plans. secondlexit
through the rear of the building must maintain 1410
I
minimum width for entire exiting system. Panic \
\
hardware to be provided on rear exit, no other
locking devices will be allowed.
~c
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---------------------------------------------------------------------
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Application Date
Issue Date
Assessor. Acct #
Site Location
Owner - Last Name
- Street
- Cit.y
- Phone
Tenant's Name
Agent's Name
Architect's Name
[X] Building
[ ] Mechani ca 1
[ ] Plumbing
07/15/1992
Application Number 92AP05463
Permit Number
Project Gr.oup
343 N. CALLOW
JACKLEY
343 N. CALLOW
BREMERTON
(206) 377-0391
First BROCK
MI
St.ate WA Zip 98310
Phone(206)
Phone(206)
[ ] Grading
[ ] Move Building
[ ] Mobile Home
[ ]
[ ]
[ ]
Sign
Burning
Land Clear
[ ] Paving
[ ] Underground
r ] Demolition
---------------------------------------------------------------------
Building Contractor:
Work will be completed by owner.
Nature of Work:
Interior remodel to create retail and storage space.
Building Valuation
$3000.00
---------------------------------------------------------------------
Council District 7 Census Tract
Construction Sq Feet Inspections
rrype Required
Residence [ ] Zoning Foundation [ ]
Business [X] Type Framing [X]
Other [ ] Insulation [ ]
New [ ] Plumbing [ ]
Repair [ ] Status Mechanical [ ]
Remodel [X] Code Wallboard [X]
Addition [ ] 12 Final [X]
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---------------------------------------------------------------------
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Application Date
Issue Date
Assessor Acct #
Site Location
Owner - Last Name
- street
- City
- Phone
Tenant's Name
Agent's Name
Architect's Name
[X] Building
[ ] Mechanical
[ ] Plumbing
07/15/1992
Application Number 92AP05463
Permit Number
Project Group
343 N. CALI,OW
JACKLEY
343 N. CALLOW
BREMERTON
(206) 377-0391
First BROCK
MI
State WA Zip 98310
Phone(206)
Phone(206)
[ ] Grading
[ ] Move Building
[ ] Mobile Home
[ ]
[ ]
[ ]
Sign
Burning
Land Clear
[ ] Paving
[ ] Underground
r ] Demolition
Building Contractor:
---------------------------------------------------------------------
Work will be completed by owner.
Nature of Work:
Interior remodel to create retail and storage space.
Building Valuation
---------------------------------------------------------------------
$3000.00
Council District 7 Census Tract
Construction Sq Feet Inspections
Type Required
Residence [ ] Zoning Foundation [ ]
Business [X] Type Framing [X]
Other [ ] Insulation [ ]
New [ ] Plumbing [ ]
Repair [ ] status Mechanical [ J
Remodel [X] Code Wallboard [X]
Addition [ ] 12 Final [X]
---------------------------------------------------------------------
---------------------------------------------------------------------
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PER M I T
A P P L I C ~ 'T.' ION
~--------------------------------------_._----------------------------
--~----------------------_..._.._-----------------------------------..-..--
Application Dt?te
Issue Date
Assessor. Acct#
Si.te Locat.i.on
Owner - Last Name
-. 8t reet.
- City
- Phone
'fenant 's Na.me
Agent's Name
Ar.chitect's Name
[X] BuiJ ding
[ :I Mechanical
[ ] Plumbing
07/15/1992
Application Number 92AP05463
Permi t Number'
Proiect Group
343 N. CALLOW
JACKLEY
343 N. CAI.r.OW
RREMERTON
(/06) 377--039.J
Fi. t'st BROCK
MJ
state WA ~ip98310
Phone(206)
Phone(206)
[ J Gr.ading
[ ] Move Building
[ ] M.ob:i.l e Home
r ] S:i gn
[ 1 Burning
[ J Land Clear
r. ] Paving
[ ] UndergrOllncl
[ ] Demo I i. ti, on
Building Contractor:
-----~---------------------------------------------------------------
Work will be completed by owner.
Nature of Work:
Interior remodel to create retail and storage space.
Building Valuation
1,1!>,1z"
$3000,00 '
Council District
- - - - - .... .- ""!" -~ .- - - ..... .,- - - .... - - - -. - - - - - - - _. -.. - - - _. - - -. - -.~ .. - - - .- ..... - - - - - -. - -. - - -, - - ..- .- - - - - - - - .....
.
Census Tract
Construct:i on
Type
Residence I: ]
Business [Xl
other []
New [ 1
Repair []
Remodel [Xl
Addition r:]
7
Sq Feet
In8pections
Required
Zoning
~
Status
Code
P'ounda t ion r J
Frami ng I: X]
Insulation [ ]
Plumbi.ng []
Meehani eel J r ]
Wallboard [Xl
F:inaJ [X]
17
~ ~ = = =" = = 7 =~ = = I =;: =~ = q ~ = = = = = = = = =" = = = = = = = = = = = = = = = =" = = = = =
CITY OF BREMERTON BUILDING DEPARTMENT
PERMIT APPLICATION
DATE:
7-15-
, 199 2
TO BE COMPLETED BY
7-27- , 1992
Brock Jackley
OWNER
owner
CONTRACTOR
343 North Callow
LOCATION OF JOB
lX1", --. ,..... -
-..;; 'IE., ...:... ~ __"
b . -_..~
JVL 1 ',,; 1992 -.J
FOR interior remodel
ENGINEERING COMMENTS/REVIEWED BY ~
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C()MMJt'W1]
,
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01
CITY OF BREMERTON - BUILDING DEPARTMENT
478-5275 - 286 FOURTH STREET, BREMERTON, WA 98310
INSPECTION REPORT
PERMIT NO.
/3? )7
,
I have this day inspected this structure and these premises and have found the following violations
of City, County and/or State laws governing same:
(I) II~~;IJ r~~b' -h.'~SI'kS c-+- 5'~7.r.5
1/ ~
S '/ I-t; "$ ~ " a.--4 8Ve ~ S :j t:>.,p...' ..,-,-~..L~ _
@ 5 ~ ;,. yo I ~ey s ;-. t1(....7 ~l)"+- ?/a,.-~ JA;1 b "C ~ 1,i f (..
You are hereby notified that no more work shall be covered upon these premises until the above
violations are corrected. When corrections have been mad? call for re-Inspection~.
Do Not Remove This Tag DATE :J !PI1>
t INSPECTOR FOR BUILDING DEPT.
~DF
INSPECTION RECORD CARD
CITY OF BREMERTON BUILDING DEP ARTIJENT
13657
PERMIT NUMBER
!
ADDRESS
OWNER
CONTRACTOR
343 N. CALIDW
BROCK JACKLEY
SELF
PHONE
PHONE
~ ilD'lIJJJ1t!IL.J...4.
-
~-
..
.,-....t;.~
1 FOUNDA liON
1. PERMIT ON SITE
2. CHECK Pu\NS TO PERMIT
3. CHECK SETBACKS
4. PROPERTY STAKES
5. FOOTING WIDTH & DEPTH
6. SOIL BEARING O.K.
7. CHECK FOR FILL
B. REQUIRED STEEL IN Pu\CE
9. CHECK FIREPu\CE FOOTING
10. ANCOR BOLTS
11. FOUNDATION VENTS
12. CRAWL ACCESS
. COMMENTS:
FOUNDATION INSPECTION
APPROVED BY:
I j,~A..
"'-
_ U.~~~l ~
1. WIRING APPROVED
2.FOUNDATION VENTS
3. SHIELD UNDER POSTS
4. POSITIVE CONNECTIONS
5. SOIL TO WOOD CLEARANCE
6. BEAM SUPPORT
7. TR. MAT. NEXT TO CONC.
B. WASHERS ON ANCHOR BOLTS
9. BEAMS PROPER SIZE
10. FLOOR JOIST SPAN
11. NOTCHING & DRILLING
12. STAIRS
WIDTH
RISE & RUN
WINDERS
U\NDINGS
HEADROOM
13. ATTIC VENTlU\T10N (upper & lower)
14. CHIMNEY STRAPS SECURED
, 5. FIREPLACE COMBUSTION AIR
16. FANS VENTED TO OUTSIDE
17. WATER CLOSET CLEARANCE
1 B. SMOKE DETECTOR
19. SHEETROCK BACKING
UNDER STAIRS
ABOVE GARAGE DOOR HANGERS
COMMENTS:
20. FIREBLOCKING
5T AIRS
DROP CEILINGS
TUBS OR SHOWERS
ROOF & CEILING LINES
FURRED OUT AREAS
FIREPLACE AT CEILINGS
HOLES PLUGGED TOP & BOTTOM
LID IN VOIDS
21. WINDOWS
MEETS ENERGY CODE CU\SS
SAFETY GU\ZING
REQUIRED ARE EXITS
WINDOW SILL HEIGHT
22. CEILING HEIGHTS
23. SWAY BRACING
24. TRUSSES
PROPERLY INSTALLED
STAMPED
PROPERLY BRACED
25. A TIIC ACCESS
26. RAFTER & JOIST SPAN
27. ROOFING. FU\SHING. SHEATHING
28. SIDING _
~ ,c;~~ ;~~I
/ 2. - ~- 9 Z
52.-
2A
FRAMING
FRAMING INSPECTION~/(L' i(f 7
APPROVED BY: yv fI'I~
..... ..~~U~l:::.ll.!I.. _
~
2B INSULATION
COMMENTS:
1. PROPER R-VALUE
2. VAPOR BARRIER
3. PROPER FASTENING
INSULATION INSPECTION
APPROVED BY:
MECHANICAL
1. PERMIT ISSUED
2. FURNACE LOCATION
3. FURNACE CLEARANCE
4. tB' VENT SIZING
5. 'B' VENT CLEARANCE
6. 'B' VENT SUPPORT
7. COMBUSTION AIR
B. DUCT SIZING
9. DUCT SUPPORT & JOINTS
10.GAS PIPING TEST
1'1. GAS PIPE SIZING
12. GAS PIPE SUPPORT
COMMENTS:
M
...
I-IVAC APPROVED BY:
GAS PIPING APPROVED BY:
WDST
1. WOOD STOVE CLEARANCE
2. CHIMNEY CLEARANCE
3. HEARTH EXTENSION
4. CHIMNEY HEIGHT
WDST APPROVED BY:
p
PLUMBING
1. PERMIT ISSUED
2. UNDER TEST
3. WATER PIPE SIZING
4. DWV SIZING
5. PROPER SUPPORT
COMMENTS:
(..
6. PROPER FITTINGS
7. REQUIRED CLEANOUTS
B. PROPER GRADE
9. HWf PRES. RELIEF VALVE & UNE
10. SEISMIC STRAP
UNDERGROUND APPROVED
BY: _
ROUGH-IN APPROVED
BY:
3
WALLBOARD
6. FIRE SEPARATION IN GARAGE
7. ATTIC ACCESS
8. DRAFT STOP IN ATTIC
9. PROPER CONST. OF FIRE WALLS
10. DROP CEILING & LIGHTING
1. LID OVER SIDES
2. NAILING
3. W/R AT TUB OR SHOWER
4.5/8 UNDER STAIRS
5. FURNACE ENCLOSURE
COMMENTS:
WALLBOARD APPROVED BY:
4
FINAL
1. HANDRAILS
2. GUARDRAILS
HEIGHT
INTERMEDIATE
3. EXHAUST FANS
4. WATERPROOFING IN SHOWERS
5. DISH\AlASHEA AIAGAP
6. FIRE DOOAS
LABLED AS REQUIRED
SELF CLOSING
7. FIRE DAMPEAS INSTALLED
8. PENETRATIONS IN FIRE WALLS
9. HOT WATER TANK PRL
10. OUTSIDE GRADE
11. SOIL TO SIDING CLEARANCE
12. SMOKE DETECTORS
13. FIREPLACE HEARTH
14. SAFETY GLAZING
15. INSULATION
WINDOWS MEET ENERGY CODE
UNDERFLOOA & ATTICE INSUL.
WATER PIPE & HEAT DUCTS
16. WOODSTOVE APPROVED
17. WINDOWS & DOORS CAULKED
FINAL PLM8. APPR. (comm.) COMMENTS:
FINAL MEeH. APPR. (comm.)
FINAL BUILDING APPR. :-LZ..
~~~~
'$-/o-? ;r
o--1u(.f-- L{ I G / 9 ~
(jj)ate:
~ ~~ ,:~?!;~=~,,~~~'
CERTIFI'CATE OF OCCUPANC": ~
i
'~i-.
COMMON USE
Appliance Repair & Parts S es ~
?fL...... ~
$~@ J)
This certificate must be posted and permanenllyma=:~:::, in a c:;: iC.Uous;Plac.~., '.' ~
~~~~~ ~~~~
""'. ~
.'" I 1L~
:' . fl'
i
i
VN
TYPE
OCCUPANCY
B2
OCCUPANCY
LOAD
TYPE
CONSTRUCTION
60
fA"
July 31, 1987
\
BUILDING ~ERMIT
~N~
4646
AI
City of Bremerton, Washington
Phone: (206) 478-5281
~---
OWNER'S VALUE
BLDG. DEPT. VALUE
PLAN CHECK FEE
RECEIPT NO.
PERMIT FEE
RECEIPT NO.
DATE
$ tf)t> ~ d c:r> $
SI-h: ADDRESS I LOCATION S ~,-"?-: /u
OWNER'S NAME /Soy #ou ~ /7-1./70. ADDRESS
CONTRACTOR 77N AJev ::e-AJC!..
RcJ 1hZ?, f I O.
$ S ~ '7 ~j / / -:3 - d'z.
/Y#-//oeA-J ~ S /33 - oCJ-' - O~t.f-c>~"1
PHONE
STATE CONTRACTOR'S L1C. #
ADDRESS
PHONE
o RESIDENCE Z BUSINESS 0 OTHER 0 NEW 0 REPAIR 0 REMODEL 0 ADDITION
o DEMOLISH
PLANNING I ZONING
FIRE ZONE
STORIES
OCCUPANCY
fi s (p~- v-
C! ~Mf f / /:;;-;?Z:. ,
V .~ c. "'f"
.72-PJl. v C1/= P ek f
J- IJ t5' ,:2./ f ~ rI t J"
p#,
/~ T r1 Od"A-
THIS PERMIT ISSUED FOR:
'AII provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.
INSPECTIONS REQUIRED: Foundation 0
Framing 0
Plumbing 0
Electrical 0
Wallboard 0
FINAL~
SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING; MECHANICAL AND ELECTRICAL.
FOR INSPECTORS USE ONLY:
REINSPECTION:
!APPROVED' NOT
TYPE OF INSPECTION DATE TIME APPROVED
COMMENT .
DATE
TIME
APPROVED
FINAL INSPECTION APPROVED BY
Building Inspector
OWNER'S SIGNATURE
Y CERTIFICATE REQUIRED BEFORE OCCUPYING BUILDING
BY Y 0 0..J t.:;
BUILDING DEPT. ~F jA/?.# I
bL4- ~JJrc
e
Fre $m...........m4m?C.............................~eiP' No. ....dc1./,R.tr.......................1
N<}
41541
BUILDING PERM IT
CITY OF BREMERTON BUILDING DEPARTMENT
F. E. IRISH, Building Inspector . ESsex 3-1411, Ext. 36
O. wner's Value I Bldg. Dept. Value I DESCRIPTION:
OA tJ t)
$ ,7 r.."O ...-' ./ Lot Block Additions
t/
Address on Job ~!.'_~~__n::-n_ ~ _f..Z __ ____)-t.:-5?_ _'n_ _/:r_<K-:f:-&-..~~~________ _________________ Date __/tJ._:~_<2?__~:":__2_Q___________
Building _nun.n.._.n x _n___nu______ and hnun_u_un stories _nmnm_n__n.__m basement. Lot _numm.n._ x _.__n._u._n._
Front Yard ___mnm_nm____.__ Rear Yard n__nmn___mm__n Side Yard _n_m_n____n__mn_ Garage hnm__n.m_m_____n____
/ . ~.
Occupancy ...h_.~~~<~:__.___..__:~!,-_~~_:<&.~_.__.__._____._____.___.__.__.____________..__.__.n_ Zone _n_.._______._._.___________.________n__
? '~. .
Owner _.h_/~;__. ~,,~0."~ ..00._00 nL:'A'~.-!,':':"y._:(~_:c;<.::?:L_ .._ n n___ Address m.n._nn. ____ nnn ___ ..nn_nnn___ n Phone _____m__nmu
I Ij'
Contractor __~~r:::~'~:"3'''::~_:hm__n.n 00 u un ___n___ ___n ___ n_ Address m_nh__n_m_mn ___u.n____ u__ u__n Phone __________m____
This permit is issued for:
..,"ll ~~~d--<....e - ..-J;.:c:..1-~<f!-- "S.- -/' ~~_6:_d~__f:d:__h__ _~f:~_____!~:>;:_:l?("_,_z_ '"l-:!~~/____~_~._!_____~~~_~~::?{_____
-f;.--"~~::.-h;;:;;z;.----"7~~;L-_.;~~_.:;i.-;nn~-A '" .AP<'L~~ r~~l!~V ~ d.~f L1_"';' ~?;." ~, ____~~_'
/cuP-d:.~~1;:;~~~~~~2~~~~~~~;~~~~e=~~~~~~~:~~~;~~:~;~~~~~~~;~,~;;~~~:t~::~~;~~4~~~~~Z~~~~~;tt4:~;;;:;~~;~~
All work to conform to all applicable building ordinances and amendments. Please note the following
special instructions and requirements.
DETACH HERE AND POST THIS SECTION ON JOB
INSPECTION - Reinforcing steel must be inspected after placing and before covering. FORMS shall be inspected
and approved before pouring. All plumbing, wiring and the frame of all buildings must be inspected and appro,yed
before co'vering. Wood preservative to be used on all wOlod against masonry. Ventilate fo'undation and attic. Sepa-
rate permits required for plumbing, wiring and heating. See City Engineer before working on streets o,r sidewalks.
~-, . ~/--,").-- ...-....... i
- - - - - - - --.' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -:::.~ - - - - -- - - -;: - - - - - :-.- ,-...- - - - - j - - - - -- - - -- - - - -.:1- - -,-;- ~.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - --
, ,. I;;~: '/ .;;., /1"_/' ',' ~~) I.' -,?I (. ~r
Owner s Signature_!.:_~'., ;'~':,_"':':-J<.:,Ph ~.:.:;;"..,'~-:(~}y'~I,:(.d.h \ no. .__ By __ u__ u__ ._. _ u.. ___ _.._. _ _... _ h_ mn m._ h h' ____ _u _ hU. __._ ___ h_. U_
/:;1' His Authorized Agent
. '. ,I,' /) 1:1;' 'f.l.. . /
Bmldmg Inspector __.. _ .D. ~!{._ _(~?~_ __~___ ~&-!':.--':~(:"'-___ __.___.. ____ ___ _. ._.. _._ __<__ ______ __ .____
/ ..
By m u. _Z~~~:~~_ __. __n u._ U. _ ___ n___ ___ U ___. __ U __ _.__ __ _n _._ __ ___ uh ___u _____
~OF
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e
.
Nfl
35847
~'""5
:'~" ';~.5-..- - -11 "1 :;,"~ 9
Fee $mm__~!___m_m__________m__m________m_________________m. Receipt No. _________~::m______m_m_____m________mm_______
CITY OF BREMERTON
BUILDING PERMIT
BUILDHo,(G DEPARTMENT
/
/
F. E. IRISH, Building Inspector . ESsex 3-1411, Ext. 36
Owner's Value I Bldg. Dept. Value I DESCRIPTION:
$ I t: ii C;' C~? ~. . -Lot Block Additions
=., /- .--<' -') ,1 '" /' r' 'J / .~
Address on Job 00 _u::~_n'(_~~. _ _ __)1. fim _ _ _ _ ._~_ .-.0:J~~. !..!-'~!... _ n' n. ___ 00__ _00 nm .m. __ _ _ _00 00_ __ . Date L__ _ ~S-n :_u _ _n _ _~~n. __. n196.:~.
Building 0000._0000_.__00 x .m__nm.__n and _n___nm_____ stories __mn.m__mm_un basement, Lcl,=./n_mm x __n.__mmn.
Front Yard m__m_m__mm.m Rear Yard .mm_nnnmmm. Side Yard m.nnn.__.__Un.___ Garage U_mn.nmn_____mUm___
g:c:~a_~~~;~~ :.~).~~3~-~,~ ~~~ ~~ fA?:~~ ~~!~~':~ ~~~~~ ~~~~ ~~~ ~~ ~~ ~~ ~.~ ~~~. Add;~~~n~ ~~ ~~ ~~~i!~ ~ Z ~ ~;&~~~ Z;:~i~5;-;.j -pli~~~~~~ ~~~~~~~~~~~ ~~
f . -. -
Con tractor _ _ _ _q(;,::~ ___ n __ 00 . i.'/. _ ,::':::&.:: .~-!:. ::-:::,.,:.;-:';':. 00 ___ 00 __ _.. Ad dress . _ _ 00 _ _ 00 _ _ 00 _ _ __ n. _... 00 _ __.. _. 00 _._. u _ __ Phone. u mm. mm
- I. . If 'I
This permit is issued for:. ,
_.....____...(l.f~i:.,t:!..__..._..__I.~~___ )(..~r?:_.........t:l!..._.._,i7:._t.".;~:J._!._..__..)'J-_<?.:1-:___.___.:l/.__ ____L~t(6z,l....-.l;~_.:t{l:c;{;_
/[4 /J (' . ,.-I' j! ,-1/. ' f' :c. "'-" I .~,,!.-." ~ /J .,,>'- (, " ,4
(iI'y~.A....~r.,..j'...~~,--,t!:~ c;-....~" e-( ...-1.1../',' ,,,,,!,,,,_ ,) ~ _J ,,-1: I:""'" P' "(,?-- }.,..;o<;"' ./j./!....l'....r\.. :./
: ~ ~: ~::::: ~ ~:::: ~;.~! ~ ~~ :j~ ~~:: ':: ~ ~ ~ :~': ~ ~~~?~ ~: ~:::::::; Z~~~:~~~:::: ~ ~,:.:~e~.;?:~~~ ~ ~::: ~ -; ~~l ~~ ~: ~: : ~ ~:~::::::::: ~: ~:: ::::::: ~:::::::::: ~::::::::::: ~::::: ~:: ~: ~.
- ~.. - ... .
All work to conform to all applicable building ordinances and amendments. Please note the following
special instructions and requirements.
DETACH HERE AND POST THIS SECTION ON JOB
INSPECTION - Reinforcing steel must be inspected after placing and before covering. FORMS shall be inspected
and approved before pouring. All plumbing, wiring and the frame of all buildings must be inspected and approved
before covering. Wood preservative to be used on all wood against masonry. Ventilate foundation and attic. Sepa-
rate permits required for plumbing, wiring and heating. See City Engineer before working on streets or sidewalks.
---.---------------------------------------.-----------------------------------------------------------..---------------------------------------..-----------------..----------..-..-
-- --_.. --.... --- -- --.... --.... --.... ---.... -- --- --- -- ---......-.. -- -- ----.. --- -- -- ---.. --- -- --.... ---- ---.... ...................... ---.................. -- -- --_.......... -- --........ -_.. ---.... --.... -- --.... --.. -- --.... ---.... ------- -----..
.. --........ -- --.. --.. -_.......... -- --.. -_......- -- --.... --.... --.... -_........ -- -- --..-.... -- -- --- -.-.. --- -- -- -- -- --.. .............. --.... --................ -- --.... -.............................. --...... --.. --.... -- - ~ -- - -- -- - ~..- ---- - ~- - ---- -----..
- - - - - - - - - - - -- - - - - -.. - - - - - - - - - - - - - - - - - - -.... - - - - - - - - - - - - - - - - - - - - - - - -.. - - - - - - - - - - - - - - - - - - - - - - -.- - - - - - - - -.. - -- - - - - - - - - - - - - -.. - - - - - ~ - - - - - - - - - - - - - - - -.. -.. - - - -.. - - - - - - - - - ~ - - - - -.. - - - - -...... - - - - - - -.
- -.. - -.. - -.... -.. - - - - - - - -- - - - - - - -- - - - - - - - - ~ -.. - - - - - - -.. - - - - - - - - - ~~~ - - - - - - - - - - - -.. - - - - - - - - -.. - - - - - -- - - - -.. - - -.... - - - - - - ~;t::::~ - - - - - - - - - - - - - - - ~~ - - -.~; - - - - - - - ~- - - - - - - -.. -.. - - - - - ~ - - - - -.. - - - - - - --
-- ---- --- -- --- --- - - - -- - -- -- -- - - - --;---: :-. -- - -- -:;;;-.. - - - - - -j- -.- - - - -- - - --_-.. -,:; - - - - - ---- - -- - - -.-.. - - - - - - - - - --- -,;.-.. - -,- - -:;- - --~- - - - -.. ~_.. -7 - - - -- - - j- - - - -- -.:;; - --- - - -- -- -- - --i;"",----- ---- ---- ---
f/;:I I......' -I' /."";'1' j,' . ;, ~ {,~ f' ;;-<..-./--;.~ ~/.(
Owner's Signa ture n~nlo ~... ::~: _ _ ~ _ _ :~~ __ (:~~:":: ?~(:-:~:::~:~__ __ 00 _ _ __ _ _. By. _ \/ _ ~_ _ _ _,~ /. _. _ _ _ _ _ _ _I.;: _ _\~'_ _ _!~~ ~:~~~~:Z_/~:::.::: _ 00 00__ n.
..AI His Authorized Ageht
B 'ld' I t.?---,;j.. ~ v I' \,1 ~ ~ "J)
Ul mg. nspector --mmm/nnG.;fi-.nmm,>G_L;:.':.;.;.:..'"._:r.n.mm.n__mmu______.m
By .0_.0000 noon. 0000____ 00 __ 00_ _ __ 00 n' __. n. n. .00_ _00 _ 00 __.. 00 _ __ _ _ __..00.. ___ ___. .00000
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