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HomeMy WebLinkAboutAPPLE ST., 243-45I This Placard must be posted on or near building and the Permit & "Approved" plans must be at the sit, Permit # BB09 00713 Call the followma Aaencv Telephone Numbers for inspections Budding Department Inspections Call (360) 473870 WATER - Public Works - Water (360) 473-5927 PW - Public Works - Engineering (360) 473-5270 HEALTH - Kitsap Co Health District (360) 337-5285 Fire - Fire Department (360) 473-5394 L&I-yDept ,of _Labor and Industry EE ction (360) 415-4000 - Propertylmes shall be properly identified and marked before foundation footing inspection Setbacks are measured to the finished wall structure - Reinspection fee maybe assessed if inspection has been requested when not ready or corrections are not completed - Permit, approved plans, engineering, and inspection card shall be on site during construction or Remspection Fee maybe assessed %7, `tv Approved�' Date Notes Foundation Footings, Propertylmes shall be pro perly identified I Foundation Walls / Hold downs `( L&I - Electrical Cover Inspection Before Framing (State of Washington) Framing Inspection (Mechanical & Plumb Rough -In, Elect Cover ; Completed) Paved Driveway & parking areas 61).14 '� ' f t- G L&I - Electrical Final Inspection t`l -trl- iJ PW - Driveway approach final (`L Final Inspection - Building w�S - f-- ��� n 0) DO NOT OCCUPY BUILDING WITHOUT BUILDING bEPARTMENTAPPROVAL PROTECT THIS CARD FROM THE WEATHER 3 PERMIT CENTER RESIDENTIAL Building Permit Application Rte- (507(3 RECEIVED City of Bremerton NOV 2 3 2009 Department of Department of Community Development ' 345 - 6th Su cc I, Suite 600 ` 111 unci tou ' WA ' 9836>{,I(i&ty Development (360) 473-5275 " Fax (360) 473-5278 c i biuricnon Nva u5 A hcant: <' owner, El Contractor ❑ Authonzed nt Site Address RL1 To apply for a property address contact Public Works at (360) 473-5270 CONTRACTOR OWNER I -/NDA / Permit Fee Address A Address ai/,3 )?PPL_E&7— City, State, Zip City, State, Zip (Lc -m j�&/u 3/ License # & Exp Date Contact Name Phone # Authorized Agent Name .5T1✓�� Contact Phone # Address y t.PFr*J 3 49io as w Email address City, State, Zip RsE2 W 4 / Tax ID/Parcel # '39U'4 -or>6_tl-4 _cc'z, Phone # (3&t� S -01-Y311 Sewer Septic Email address !t& p , COht Wha(fi thea plication for? ,(Please,check),,` ,❑ New Construction i4ljeratiorf `- Addition ❑ NEW SINGLE-FAMILY RESIDENCE ❑ RESIDENTIAL REBUILD ❑ NEW DUPLEX RESIDENTIAL ADDITION ❑ NEW MANUFACTURED HOME ❑ RESIDENTIAL REPAIR NEW GARAGE/CARPORT ❑ NEW ACCESSORY BUILDING DEMOLITION sf Interior sf Exterior— sf Foundation Wall— sf Roof/ Section— "" Separate demolition permit and fees required Contact Public Works for sewer cap permit (473-5270) Sewer must be capped poor to demolition permit issuance OTHER IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? ❑ YES NO Scope of work proposed Cj 1 A(6 QDD J V DAj ~ oQ C J9& t2 I ,t'r 1WC_, Square Footage: Building 1st Floor Basement Garage 1st FlFloor _n4a 2nd Floor Other 2nd Floor Deck(s) Valuation Plan Review Fe Permit Fee Surcharge Total Fees 061.06�(4,5_0 yus bs- Application for which no permit is issued within 181 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 applicant showing that circumstances beyond the control of the applicant have prevented action from being taken No applicant shall be extended more than once In order to renew action on an application after expiration the applicant shall resubmit plans and pay a new plan review fee .sT-j?,o& arLeTr I z o? Applicant's Signature (Print) Date Rev Oct 2009 P, CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 345 - 6th Street Bremerton, WA 98337 (360)473-5275 Fax (360)473-5278 ASSESSOR NUMBER 3964-000-117-0008 APPLICANT NAME RITTER LINDA OWNER NAME RITTER LINDA CONTRACTOR SELF LENDER NAME SUBMITTED 11/23/2009 VALUATION Budding Permit Plan Review Fee State Surcharge TOTAL FEES $20,00000 $26700 2211 $17355 4580 $450 0236 $44505 PERMIT NUMBER BB09 00713 DATE ISSUED 01/19/2010 ZONING R10 SITE ADDRESS 243 & 245 APPLE ST PHONE (360) 271-1117 ADDRESS 243 APPLE ST BREMERTON WA 98312 PHONE (360) 271-1117 ADDRESS 243 APPLE ST BREMERTON WA 98312 PHONE ADDRESS PHONE 0-ADDRE APPROVED 01/19/201 I ATION 07/18/2010 STATUS ISSUED Budding Permit - No Mecham 2 -CAR GARAGE ADDN Building Code Edition Occupancy Group Type of Construction Flood Zone Setbacks Sanitation Method Number of Bedrooms IBC 2006 (Front) (Side) (Rear) (Other) Square Footage Bid Price from Applicant TOTAL Inspection Requests FIRE Fire Inspections (360) 473-5394 DCD Building Inspections (360) 473-5870 HEALTH Kitsap County Health District (360) 337-5285 L&I Department of Labor and Industries (360) 415-4000 PW&U Public Works - Engineering (360) 473-5270 This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at anytime after the work is commenced for a period of 180 days It is the responsibility of the permit holder to see that the required inspections are made Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code requirements Any demolition testing or financial burden shall be borne directly by the permit holder Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction I hereby certify that I have read and examined this permit and know the same to be true and correct All 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 provisions of any State or local law regulating con uction or the performance of the construction If listing the owner as general contractor I certify that I am exempt from the requirements of the State Contractor s Registration Law unde Section 3 Chapter 126 Laws of 1967 All revisions to an approved plan require DCD review and approval prior to performing work All budding and tenant occupancy permits are required to assjnal inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy I have read, and agree to abed the conditions of this permit including all conditions of zoning, building codes, an to and Federal laws SIGNATURE OF OWNER /AGENT 41LIA ki ( �� �1-d � /�^\� PRINTED NAME I ----L / f -nATF CONDITIONS City of Bremerton's app val of this application p rtains only to the City's r latory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliant aws 10 (DCD-02) DCD Validity of permit The Issuance or granting of a permit shall not be construed to be a J -L permit for, or an approval of, any violation of any of the provisions of the Washington State Building code or of any other ordinance of the City of Bremerton Permits presuming to give authority to violate or cancel the provisions of the Washington State Building code or other ordinances of the City of Bremerton shall not be valid The Issuance of a permit based on construction documents and other data shall not prevent the budding official from requiring the correction of errors In the construction documents and other data The building official Is also authorized to prevent occupancy or use of a structure where In violation of the Washington State Building code or of any other ordinances of the City of Bremerton �} 10 (DCD-01) DCD Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials In the work area or structure The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner - Page 1 of 2 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 345 - 6th Street Bremerton WA 98337 (360) 473-5275 Fax (360) 473-5278 PERMIT NUMBER BB09 00713 DATE ISSUED 01/19/2010 ASSESSOR NUMBER 3964-000-117 0008 ZONING R10 SITE ADDRESS 243 & 245 APPLE ST APPLICANT NAME RITTER LINDA PHONE (360) 271-1117 ADDRESS 243 APPLE ST BREMERTON, WA 98312 OWNER NAME RITTER LINDA PHONE (360)271-1117 ADDRESS 243 APPLE ST BREMERTON WA 98312 CONTRACTOR SELF PHONE ADDRESS LENDER NAME PHONE 0- ADDRESS plans are not available on site, or the work Is not ready for Inspection, approval will not be SUBMITTED 11/23/2009 APPROVED 01/19/2010 EXPIRATION 07/18/2010 STATUS ISSUED L&I - Electrical Cover Inspection Before Framing (State of Washington) Framing Inspection (Mechanical & Plumb Rough -In, Elect Cover Completed) Paved Driveway & parking areas L&I - Electrical Final Inspection PW - Driveway approach final Final Inspection - Building Page 2 of 2 occupied single family residences) DCD For more Information, please contact Clean Air Agency through their web site at www cleanair org or by phone at 800-552-3565 or 206- 689-4058 The L&I web site can be found at www, Inl wa gov/p-ts/asbestos/asbestos htm 10 (DCD-47) DCD Reinspection Fee All approved plans, the printed building permit, and the permit Inspection placard, are required to be on-site for Inspection purposes, and work to be inspected shall be complete and ready for inspection If an Inspection Is called for and plans are not available on site, or the work Is not ready for Inspection, approval will not be granted In addition, a re -Inspection fee will be charged and must be collected by the Department of Community Development prior to any further inspections being performed or approvals granted 10 (DCD-50) Final Inspection Required All building permits shall have a final Inspection performed and approved by the City of Bremerton Department of Community Development prior to permit expiration The failure to request a final inspection or failure to obtain final approval prior to expiration may require a reactivation fee, or a new permit application If more than a year has passed with no activity 11 (DCD-14) DCD Approved Plans, Engineering, Site Plan, Permit, and Conditions shall remain on site and be available for Inspection 12 (DCD-32) Changes to Plans Any changes to plans shall be approved before construction Is performed Architect or engineer of record shall approve the change before submitting a revision A revision Is subject to a revision fee and additional fees for plan review and inspections 50 (LU9) All driveways and areas used for loading, parking, and maneuvering motorized vehicles shall have a paved surface Two off-street parking spaces are required for every residential unit pursuant to BMC 20 48 55 (OTHER) Gravel parking surface on corner of lot MUST be removed prior to final CAL inspection/occupancy 60 (OTHER) All development standards MUST comply with BMC Title 20 65 (LU10) Approval for a non -habitable, non-commercial, accessory use only 120 (ENGR-3012) ENGR Install new driveway approach per City Standards Pave driveway approach to d 7L existing garage MINIMUM INSPECTIONS REQUIRED To request an inspection, please call (360) 473-5870 and be sure to provide your permit number, name on permit, site address, contact phone number, and inspection type Foundation Footings, Property lines shall be properly Identified Foundation Walls / Hold downs L&I - Electrical Cover Inspection Before Framing (State of Washington) Framing Inspection (Mechanical & Plumb Rough -In, Elect Cover Completed) Paved Driveway & parking areas L&I - Electrical Final Inspection PW - Driveway approach final Final Inspection - Building Page 2 of 2 B R E K '�-- R'' T© N B U 1,, IL D' I N G D E P A R T M E N T P E R M I Application Date 05/23/1994 Application Number,94AP07640 Issue Date 05/23/1994 Permit Number 15448 Assessor Acct # Project Group Site Location 245 APPLE Owner - Last Name RITTER. First OWEN MI _ Street 245 APPLE City BREMERTCN, State WA Zip 98310 Phone (206). 69.2-8709 Tenant's,Name Phone(206) °- 'Agent's Name Phone(206) - Architect's Name [ Building, IA Grading ]:Sign, [ ] Paving [X] Mechanical [ ] Move Building. [ ] Burning ] Underground [ ] Plumbing { ] Mobile dome [ ] Land Clear Demolition Building Contractor: Work will be completed by owner. Nature of Work: 'Council District. Census Tract Construction Sq Feet Inspections 'hype Required Residence [X] Zoning .Foundation [ Business [ ] Type Framing [ ] Other [ Insulation'[ � New [ ] Plumbing [ ] Repair ] Status echan'ical [X] Remodel [ ] Code Wallboard [ ] Addition ] Final [X] Received By Approved By: B R E M E R. T Q N 4-P I L LD,J, N .G D E PARTMENT M E C H A NI- , C- =A L ,, ,.�, E R M I- T A P P L.9. I C A T I 0 N Application Number 94AP0764o Work will be completed by owner. stoves -. 1 Fire Place Inserts, Furnaces Conversion Burners Unit Healer Bailers 1 Gas System. Max 5 Outlets Evaporation Coolers Air Conditioning Units Heat Pumps',.., Mixing or`Re-Heat Box Air -_.Hand 1in(g Units Ea.. Ranee Hoods Cl then 'Dryers Incinerators Duct Alterations Wanks Reirige'ration'Units . Other items APPLICANT: � OWNER p CONTRACTOR OTHER: COMMENTS: SITE ADDRESS , 0-'ADDR CONTRACTOR LICENSE # �(-9/bIARATION DATE: OWNER PHONE # CONTRACTOR PHONE ...... ............. .. . .... SP . ....... ..... RANGE WATER CLOSET STOVE BATHTUB iWOOD/PELLET L GAS FURNACE bres:LAVATORY CONVERSION BURNER kuk SHOWER UNIT HEATER btu k KITCHEN SINK BOILER btu k DISHWASHER GAS PIPING LAUNDRY TRAY EVAPORATION COOLERS btu's: CLOTHES WASHER AC UNIT btu k, WATER HEATER HEAT PUMP btuk tow., URINAL REHEAT BOX btu' , DRINKING FOUNTAIN AIR HANDLING UNIT bur's: FLOOR SINK OR DRAIN EXHAUST FANS SLOP SINK RANGE HOOD (residential) WATER PIPIING & ALTERATION RANGE HOOD (commercial) GREASE TRAP/INTERCEPTOR CLOTHES DRYER HOSE BIBBS INCINERATOR LAWN SPRINKLER SYSTEM DUCT ALTERATION SWIMMING POOL TANKS toe.- BLDG. SEWER (mobile / moved house) REFRIGERATION UNIT ROOF DRAINS OTHER. OTHER: MECHANICAL PERMIT FEE wa, $15-00 PLUMBING PERMIT FEE (15.00 or 4.50) MECHANICAL FEES: APPLICANT'S SIGNA TE: "-�,h", -/I- SRE.MERTON BUILDING nivPikRirmEt4iT RECEIPT # 087312 This Is Not A Permit * May 23, 1994 Permit Fees Amount Paid Plan Check Fees Amount Paid Mechanical $ 24.50 $ 24.50 62-322.1005 Other Fees Zoning Fees $ Wo 100 62-3450300 Gen Payment Other Fees .00 Energy Charge State S/C 643-237�13 Total Feet 24.50 Amount Paid $ 24.50 Prior Payment $ 00 Balance Due $ $ 2400 $ 24,50 Received From: On 05/23/1994 Economy Sheetmetal #9243 For #94AP07640 CITY OF BREMERTON — BUILDING DEPARTMENT 4,78-5275 - 286 FOURTH STREET, BREMERTON, WA 98310 INSPECTION REPORT PERMIT NO. 1 have this day inspected this structure and these premises and have found the following violations of City, County and/or State laws governing same: 6 -e 'As /6,fs ,e) _ I� S� ,G�i�S' /�A ff 7�y r,!n 114 Re_CY7 07-- 4e,2 7-- (C7a'G You are hereby notified that no more work shall be covered upon these premises until the above violations are corrected. When corrections have been made call for re -inspection. Do Not Remove This Tag DAT Z INSPECTOR FOR BUILDING DEPT. 02 BREMERTON BUILDING (DEPARTMENT Plumb-log/Mechanical Inspection Report GAS PIPING Linder ate t (10psi 15 minutes Pro sizi ng & su .ort 12'" tnhrnum, blow grade when underground Co-ated/wra when ti� nner and oc'vKi'n'G" of earth Groundrjohnt unions rohibited in cerrain'loc ations liushin not allowed in concealed ureas COMMENTS.-- GAS OMMENTS:— GAS PIPING APPROVED: FURNACE. Manufacturer's,s fications on site Locatiot4, access, support Clraranae to combustibles Venting: clearance to eombustibks Vint sizing & 9,Uort/connectlons Vent termination Combustion air Chi.. liner and/or se amte flues as muired Gras shut-off vvithin 3' Pilotr6ated off floor in garage - Ducts: size & su art/insulated when required Return air COMMENTS:. FURNACE APPROVED: MISC. "Pt.I,AN 'SBS Manufacturer's specifications on site Location, access, support Clearance to combustibles Venting: ckatanm to combustibles Vent sizing & su ; ort/connec: dons _ Vent termination Combustion ahr Chun .. liner and/or se craw flues as : aired Gas shut-off wididn 3' Woad stare & fir laces:_ ro heart/► Wood stores: EPA a roved Gas :1 : safshut-off Wood stoves & f re laces: tight fiq�ing doors Gas shut-off within 3' Seiaxnic stra . COMMENTS: MISC. APPMNCES APPROVED: WATER HINTER Manufacx m, #s spea'6canons onsite Location, aces, suppog - Cleamum to combustibles Venting: clearance to combustibles Vent sizing & su ort/connemons . Vent termination Combustion air Chinur liner and/or Mai -Am flaw as Mwred 'Gas shut-offwithin _Y Pi -lot e"ted offloor in r. - Gate vake on cold watersu Relief valve drained to outside l,q2 to - ahraniizeA connections Unions on warner i Seiaxnic stra . COMMENTS: WATER HEATER APPROVED: ALL WORN iJNDIIt THIS PERMIT APPROVpI: .r y a Fee$---- -3 -�---------------------------------------------------- Receipt No....... - j �---_------------------------ N° 38648 BUILDING PERMIT CITY OF BREMERTON - BUILDING DEPARTMENT F. E. IRISH, Building Inspector • ESsex 3-1411, Ext. 36 Owner's Value Bldg. Dept. Value DESCRIPTION: $ �-}Ca `Lot Block Additions Addresson Job ------------------------------------------------------------- Date -------------- ' --11? ----- 196.?- Building ---------------- X ---------------- and ---------------- stories ------------------------ basement. L t -------------- X ---------------- Front Yard ------------------------ Rear Yard ------------------------ Side Yard ------------------------ Garage ---------- --------------------- Occupancy--------------------------------------------------------------------------------------------------------- Zone ------------------------------------------ Owner--------- - -------------------------------- Address -------------------------------------------- Phone ---------------- Contractor-------------------------------------------------------------------- Address -------------------------------------------- Phone ---------------- This permit is issued ,for: --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -- -- _ _=-`--------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. ---------------------------------------------------------------------------------------- I ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Owner's Signature ogw OF f`= By His Authorized Agent Building Inspector ------------------- By---------------------------------------= :�=--------------------------------------.-_--- UiLbNC .skip Nam,/ Yf Type of Censtructi6n Address le Phone Date Received NLW REMODEL ,4 ,.I ADDITIdr- -ALTERATIOr— Building Department`Approval Date 'Permit Issfied PLANNING DEPT. Initial Date Received Approved Date Approved Not appriwed, Comments Correction Not Per-Eit ENGINEERING DEPT. Approved Approved Correction Required Initial l Sanitary Drainage Storm Drainage Gas Mains ► Underground Utilities Sidewalk Driveway Date Received Comments Date Approved TRAFFIC DEPT. Initial Date Received Approved Date Approved Not approved Comments Correction PLUMBING DEPT. Initial Date Received Approved Date Approved Not approved Comments Correction ELECTRICAL DEPT. Initial Date Received Approved Date Approved —Not Approved Comments Correction 67 2-43' A146 Pole .I /Z A IsTeAr G% Fee$....... ................................................... Receipt No. `"�? ` --- ................. N? 4486,8 '� BUILDING PERMIT CITY OF BREMERTON • BUILDING DEPARTMENT F. E. IRISH, Building Inspector • ESsex 3-1411, Ext. 36 Owner's Value Bldg. Dept. Value DESCRIPTION: Lot Block Additions Address on Job---r'@s =; = k=''=`-------------------------------------------- Date ------ '= ---------------- Building ---------------- x --- ------ and ---------------- stories ------------------------ basement. Lot ---------------- X ---------------- Front Yard ------------------------ Rear Yard ------------------------ Side Yard ----------- ------------ Garage ------------------------------ OCCUPANCY PERMIT REQUIRED BEFORE OCCUPYING BUILDING Zone __________________________________________ Owner-,.,,__� �:� �--=�=�=�==='--------------------------------- Address -------------------------------------------- Phone ----------------- Contractor .- __ _ >`=" =� Address -------------------------------------------- Phone ----------------- This permit is issued for: .�.-_ ----------------- ------------_------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- 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. ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ------ ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------- Owner's Signature------------------------------------------------------------ By ----------------------------------------- ------------------------------ His Authorized Agent Building Inspector ---------------------------------------- Rv -' ,