HomeMy WebLinkAbout29TH ST, 330 E......�
CITY OF BREMERTON • 239 4th Street •Bremerton, WA 98337
Sept 19, 2001
Maria L. Tagiorio
330 E 29" St.
Bremerton WA 98310
Dear Ms. Tagiorio,
Upon review of our application, it has been determined we need more information to
further process. The site plan needs to show an area for off-street parking. By remodeling
the garage into an office, it appears the off-street parking was eliminated. Please resubmit
with that information.
Please call me if you have any questions.
Sincerely,
'cv
alarie
Building Development Specialist
* Equal Opportunity Employer *
LICENSE APPLI
BUSINESS ADDRE
61,01-06S7
'REQUEST TO DELAY
BUSINESS LICENSE ISSUANCE
CO(cf WPC
ANT. Z-,= _ 6 fi -'P-a
SS• '�n
BUSINESS PHONE: Y6C) lr�
DETAILED DESCRIPTION OF CODE VIOLATIONS AND RELATED PROBLEMS:
ESTIMATED TIME FRAME FOR
ENFORCEMENT O
(LEAD PERSON FROM YOUR DEPARTMENT' WHO WILL BE WORKING WITH APPLICANT)
PHONE �D t J
SIGNATURE:. DATE:
Upon receipt o f/t s request, Tax & License Division will pronptly send an initial letter of temporary denial to the applicant
detailing the above code violations but will not be responsible for follow-up communication with applicant. If your
department initiates a request for delay, it is your responsibility to work with the applicant until resolution. Please return
the approved application to Tax & License as soon as the applicant has complied with code requirements.
In the event there is no resolution of code problems within 30 days from this request, license issuance will be reconsidered
by Tax & License provided there are no pending life safety issues.
'REQUEST FOR DELAY MUST BE RECEIVED WITHIN FIVE WORKING DAYS FROM
APPLICATION DATE.
Forward to Tax & License Division - 5311
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APPLICANT: OWNER ❑CONTR.ACTOR ❑AUTHORIZED AGENT
1 Sits.: Addtcss:--'_"' Q - C 1 -`1 W) ._>A Tax Account Number: CS
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Owncr._.��LLT% V -,y-j 1k\ 0 U Address:(�A
Address:
�VC:vntr<tctot I.icensc#._ �, -- — Expiration .Date:
(,-ootact llctsorl:
Contact Phone#:
Cl et;te )e of apphc.ation for hcl4):
❑ SF RESIDENTIAL NEW ❑ COMMERCIAL NEW
❑ DUPLEX ❑ COMMERCIAL REMODEL
❑ MANUFACTURED HOME ❑ COMMERCIAL ADDITION
❑ RESIDF.N'I'IAL REMODEL ❑ COMMERICAL REPAIR
IJ RESIDENTIAL ADDITION ❑ MULTI -FAMILY
El RESIDENTIAL RF --.PAIR ❑ TENANT IMPROVEMEN`
IL%I GARAGE
rl ACCESSORY BLDG
C� rds: _)
Scope: of Wt-)tk Proposed: ? � ��.� C1 C - !i"� cA.1 �,.A3(-V,
S l ra '' t't..AL=�� t7 L. C:1L t.- t It r, +v1# J�_ S-I�1.. t:jl..c r)
Square Footage, (j� (, Dwcliutg:
Garage: \,r I U Decks:
IS THIS PROPERTY WITHIN 200 FEET OF A. SHORELINE?
YES-- NO ---
I
Applications for which no permit is issued within 280 days following the date of application shall expire by limitation, and plans
and other data submitted for review may thereafter be returned to the applicaat of desttoyed by the building c,fficial. The building
official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant shov,-ng
that circumstances bcyond the control of the applicant have prevented action from being taken. No applicant shall be extend -d
mute than once. Itt order to renew action on an application after expiration, the applicant shall resubmit plans and pay a new plan
review fee.
'PI., CANTS SIGNATURE ev "I �
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PERMIT CENTER.
Residential Site Plan Review Questionnaire
P.01
P,rriiit applications are reviewed by our staff to make a preliminary determination of the presence or
absence of unique areas on the property. To help us make this detenaunation, please supply the following
information with a scaled and dimensioned site plan.
Applicant Fame:
Description 4of Proposal: VX 1 1, h, Ci Kit: r l C , C-.4\.2. n t;-� v is (_ k 1-v� SIT o/+ tin
Street Address (or cross streets if no address has been assigned):
Ir;7 �n 5' ? "l 10 'A L"t1ViL 1L2/� j,U C1ts
Tax Account Number:
Critical Area Questions:
1. Is there any standing or running water on the surface of the site at ANY time during the year".
if YES, please describe conditions: /
YES V NO
2. Has Any portion of the site been identified as a wetland? YES ___j/ NO
If yes please describe:
3. Is the site chameterized as: Forest Cleared kZ Developed
4. is the slope of the property; ---Flat V Gentle Slope Steep Slope
S. Is this propcity within 200 feet of a shoreline? Yes
G. Will tile�praposed structure be aesthetically or functionally disruptive to surroiuiding properties the
l neighbo hood, or the community? N L
Steep (15%4')
15 ft or more
ntle I 3 ft or less
Flat (0% to 3%)
100 rt.
The appiicala hereby certifies that all of the above statements and the information contained in any other
tram,mittals made herewith are true, and the applicant acknowledges that any action taken by the City of
Bremerton based in whole or in part on this application may be reversed if it develops that any such
statement or other information contained herein is false.
�.h ` C . 1�. ti �.v c/lrias�ai rJQaur�ilotlo" f b j
Signature ofpplicantaunciion {�� 98.3111Date
OF B
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PERMIT CENTER
286 Fourth Street Bremerton, WA 98337
Phone: (360) 478-5275 Fax: (360) 478-5278
HOME OCCUPATION BUSINESS
Home Occupations are permitted in specific zoning districts as "Allowed Accessory Uses" to the primary
residential uses. A home occupation is typically a small business operated in or from the home by the occupants of
that home. All home occupations are subject to the following limitations (Bremerton Municipal Code (BMC),
Zoning Code Chapter 21.02.240):
1. The home occupation shall be clearly subordinate to the use of the dwelling unit for residential purposes.
2. The home occupation shall be wholly situated indoors.
3. No person may be employed in the home occupation unless a resident of the dwelling unit.
4. There shall be no exterior display, storage or other exterior indication of the existence of the home
occupation provided no more than one unlighted sign not exceeding two square feet in size attached flat to
the main building bearing only the name and occupation of the occupant shall be permitted.
5. In addition to off-street parking required for the dwelling unit by BMC Chapter 21 Appendix Figure 670(a),
additional off-street parking is required for one patron. No parking shall occur in the required setbacks.
C 6. -Sales are limited to roducts Droduced on the premise. Products produced elsewhere may be handled as a
function of the home occupation, provided the business is primarily involved in the product's distribution and
does not attract buyers to the property for retail or wholesale sales.
7 Sales and services to patrons shall be arranged through appointment to the end that only one person vehicle
is on the premises at the same time.
8. Not more than fifty (50) percent of the gross floor area of the dwelling unit may be devoted to the home
occupation, and the garage shall not be used in the business unless the required off-street and customer
parking can be adequately accommodated elsewhere on the site.
9. Home occupations involving non-automative equipment maintenance or servicing, beauty or barber shops,
and the sielling of products that are not produced on the premises shall require an Administrative Special Use
Permit. Automative body or engine repair and painting are specifically prohibited as home occupations, as
are other small engine repair services or similar businesses that are likely to result in noise.
10. Persons engaged in legal home occupations on the effective date of this Ordinance shall be considered legal,
provided the operation is consistent with all of the above -listed performance standards. Any home
occupation that was legally established but does not conform to all those standards may not expand or
enlarge and shall terminate that use upon (1) change of use or ownership of the property, or (2) written
complaint of adjacent or nearby property owners, after due notice and hearing, if the Director of Community
Development determines that the home occupation is interfering with the use and enjoyment of the
neighboring premises and is not compatible with the residential environment in which it is located.
2165 LO —CP 19 - 61
OFFICE USE ONLY2 r <r- r OFFICE USE ONLY
Receipt , — 0,4 7-56 i.als CITY OF BR9WRTOW, Lic. #
TAX & LICENSEIDPWISlCR
Fee Due Initials 239 Fourth Street AR j 9 2001 slued:
060. //" 0 Bremerton, WA 98337
Li` Application Fft (PRORATED) 1 ,f� (360) 47813h1
<�
(Make Checks Payable to City Treasurer) BUSINESS LICENSE O b i1 D
D
(or General Regulatory License Application -Lic. Fee Due $ ) U1
(License Tvoe 1 _ EM To
Firm Name: �PIL N'v1 11`tw�i.�- Owner Name: �� ��� �- • ��TC>t'��
Address: _3,;�O Home Address: SA 11/1 E
City/State: j2.c�%.�E�1�N WR Zip Code. q', City/State: Zip Code:
Tax Returns To Be Mailed To: S PriME P\ (—
Date
Date Business Started in City: A 0") a�oD I Bus. Phone: Ur4JD - 044 0 Home Phone:
Nature of Business: 1 RAS V k -
Type of Ownership: Sole Owner
Corporate Headquarters Phone:
(Designate whether Retail, Wholesale, Manufacturing, Service, etc., and specify Product or Service provided)
Partnership ❑ Corporation ❑
Names/ Addresses/ Phone of Partners or Officers of the Corporation:
WA State Tax No.: _
Contractor License No.:
Kitsap Co. Assessor's Tax Accnt. No.:
(business premise)
Will there be remodeling/ altering of an existing building for your business? Yes ❑ No ` No. of Employees
If tenant, property owner's name: �A{ l k- A 7` A A -L -C e -\-jh Qno"R-c n
Is this tenant space currently vacant? Yes ❑ No [!�' If no, explain \
Will you be sharing this tenant space with another business? Yes ❑ No,yes, who?
Do you operate this business out of your home? Yes ❑ No Z"
ENT
Business Square Footage
Office
Retail
Kitchen
Dining
If yes, will any person be employed at the home other than a resident? Yes ❑ e:: Storage
If home occupation, I have read and agree to abide by the Home Occupation Regulations of Bremerton Zoning Ordinance Ch. IV, Sec. 9. Yes --' No ❑
PERSONAL DATA: REQUIRED OF ALL APPLICANTS z1/0 1
(If Corporation, An Officer Must Complete This Section)
s
PERSONAL DATA: Birthdate: -� -LJ 2 Soc. Sec. No.: — - g� ' 3 Driver's Lic. No.: I M�- �S Verified
Addresses for Past 5 Years: G A,5= -T- --LO" �-,W M FV --TD J LOA ck31 _u - _--
Emergency Contact: (Name/ Phone) 1. 'r tJ tJ phG 1111 C bo G c'1 "?-- _2
The undersigned hereby certfrres that the information provided on this application is true and correct, to the best of his/her knowledge under penalty of perjury under the laws
of the State of Washingon:
Print Full Name: �►P�R\/� �- 'Tk 6CRIbTitle: blffiok I Signature:
DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED Date:_/-
BUSLIC
AIL BUS ID #
T E „
E
PROP ID #TEaR(
WHITE—TAX & LICENSE CANARY—PLANNING GREEN—BUILDING PINK41RE GOLDENROD—POLICE
OF BREMI ERTON • 239 4th Street • Bremerton, WA 98337
CITY OF BREMERTON
DEPARTMENT O F COMMiJN = TY D EVELOPMENT
TAGORIO RONALDO/MARIA
330 E. 29TH ST
BREMERTN WA
98311
Sep 07, 2001
SUBJECT: Application No: 01-0215
Site Address: 330 E 29TH ST
Your building permit for the above site address is ready to issue. The balance
due is $ 43.28.
Permit Center office hours are from'844D_a.m. to 5:00 p.m., Monday
through Friday. Please contact me at (360) 478-5275 if you have any
questions.
Sincerely,
� 1 n
Building and Development Specialist
• Celebrating 50 Years of Freedom 0
r OFBRF
onus
TAX & LICENSE DIVISION
239 4th Street • Bremerton. Washington 98337 • (360) 47t
April 2, 2001
Maria L Tagorio
330 E 29th ST
Bremerton WA 98310
Re: Temporary Delay of Business License Application
Olympic Peninsula Travel, 330 E 29th ST
Dear Ms. Tagorio:
CLei. uuL9
APR 0 4 2001
D
BREMERTON
BUILDING DEPARTMENT
� �,,r Alv-'�
Thank you for applying for a Bremerton Business License for your location at 330 E 29th St.
Before your application can be approved by the City Clerk's Office several code requirements
must be met. Please refer to the attached report.
You are encouraged to work with Valarie Wolf, Community Development. She is the city official
who has put a hold on license issuance. The Tax and License Division will not issue your
business license until licensing requirements have been met and Community Development has
approved your application. If you need assistance or more information please call Ms. Wolf at
478-5244.
Sincere
Paula Johrfston
Deputy City Clerk
PGJ/med
Encl.
cc: Valarie Wolf
* Equal Opportunity Employer *
LICENSE A
BUSINESS
'REQUEST TO DELAY
BUSINESS LICENSE ISSUANCE
BUSINESS PHONE-- l C�
DETAILED DESCRIPTION OF CODE VIOLATIONS AND RELATED PROBLEMS:
0 (1-1 PYO PI C ei /Yi s,dc-
7-P-a v eel
ESTIMATED TIME FRAME FOR
ENFORCEMENT O
a.EAD PERSON FROM YOUR DEPARTMENT WHO WU.L BE WORKING WITH APPLICAN!)
PHONE � 0 `t % 5
SIGNATURE: DATE: �� t
Upon receipt o=est, Tax & License Division will pror�� an initial letter of temporary denial to the applicant
detailing the a e code violations but will not be response r follow-up communication with applicant. If your
department initiates a request for delay, it is your responsibility to work with the applicant until resolution. Please return
the approved application to Tax & License as soon as the applicant has complied with code requirements.
In the event there is no resolution of code problems within 30 days from this request, license issuance will be reconsidered
by Tax & License provided there are no pending life safety issues.
'REQUEST FOR DELAY MUST BE RECEIVED WITHIN FIVE WORKING DAYS FROM
APPLICATION DATE.
Forward to Tax & License Division - 5311
.I's bF BRt
G1
* O
�=AL
If TAX & LICENSE DIVISION
239 4th Street • Bremerton, Washington 98337 • (360) 478-5311 • FAX (360) 478-5200
April 2, 2001
Angela Thomas
107 Lopez Ln NW
Bremerton WA 98311
Re: Temporary Delay of Business License Application
Cafe Espresso, 3850 Kitsap Way Ste 104
Dear Ms. Thomas:
Thank you for applying for a Bremerton Business License for your location at 3850 Kitsap Way
Ste 104. Before your application can be approved by the City Clerk's Office several code
requirements must be met. Please refer to the attached report.
You are encouraged to work with Valarie Wolf, Community Development. She is the city official
who has put a hold on license issuance. The Tax and License Division will not issue your
business license until licensing requirements have been met and Community Development has
approved your application. If you need assistance or more information please call Ms. Wolf at
478-5244.
S
Paula Johnston
Deputy City Clerk
PGJ/med
Encl.
cc: Valarie Wolf
* Equal Opportunity Employer *
•REQUEST TO DELAY
BUSLN"ESS LICENSE ISSUA.YCE
LICENSE APPLIC.-07
BUSINESS .ADDRESS:
BUSDtiESS PHONE:
DETAMED DESC.R=ON OF CODE VIOLATIONS AIN -D RELATED PROBLEMS:
J
ESTrviA—= TLyfE FRA.1E FOR COMPLLA�N, (M
ENT•ORCE. Er'i OFFICEER, �%-
:LZ-kD PE_ASCm —ROM `!OL -R ]E'.&.7:ME'C"NHO 'NII:. 3E 'NORr—NG Wr-l-i A2.-T—"Yr)
PHON(
J
,f
SIGNA"''L'R�v -
Loon reccipc dt Glu recuesr. Tax & :C---= Zimlon wM ?rompc:,v send an inicW Wester of :emoorary denial to :he applicant
de:aiiing :he above Ade violations but .vrU not be responsiole .`or °oilow-up communication with apadcnc. If your
decart:nenc :rupates a -cauca ,or de!av, .'c s your -esvonubuity?o woric with the apolicanc :until resolution. Please return
:he aoorrved application :o Tax 3c L.*=-= as soon as the applicant has complied Frith code - uirements.
!n :he --vent there s no resolution of code ?robierns within 30 days from :his rcQuesL Ucense issuance •ArM be reconsidered
;v Tax & L '=nse provided there are no pending life safety issues.
'REQUEST FOR DELAY NIUST BE RECEn7ED WITHLN- FIDE WORIC[ G DAYS FROM
APPLICATION DATE
Forward to Tax do Licc: se Division - 5311
Owner, TACORIO RONAl.00/MARIA
330 E. 29TH ST BREMERTN WA 98313.
Contractor: CDR SERVICE Cu. (,qa- C1r1q 0 360-692-999Lic #: CDRSEC*08206 Exp. 10-24-2000
P.O. BOX 1157 SILVERDALE, WA 98383
Dass: DEMOLITION OF A SHED
Valuation * permit Fees: 6.00 Total Calculated Fee: 10.50
.00 * Plan Check Fees: Additional Fees: .00
x Other Fees: 4.50 Total. Permit Fee: 10.50
This permit shall become null and void if the building or work authorized by this permit is not cco"nced within
180 days from the date of such permit, or if this building or work authnrixed by such permit is .su$Penled or
abandoned at any time after the work is commenced for a period of 190 days.
NOTICE' - - 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
tv borne directly by the oermit 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 wank 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 regulati(\ng construction or the performance of construction.
5ignati.�re: C�,IM,�G�'_ Date
I certify tha am exempt from the requirements of the state contractor's registration law, under
Section 3, ChaptlDr 125, laws of 1967.
Signature:._ ..— _ _ Date:�
Permit Center ---Approved By. +. __ _.___. Date:
E3F:;,"FEE MEFRTON F=P FFZM="T
CC I—= ITER
286 4th Streets Bremerton,
W.4 9833.7'
Phone: ( 360) 478-5275 FAX
(:360) 478-5278
BUILDING PERMIT
Job Addr:
:330 E 29TH ST
Permit No:
00•-020?
Location:
Status:
ISSUED
Parcel No.
3969000-019M0002
Applied:
05/01/2000
Issued:
05/01/2000
Applicant:
rAGOR10 RONALDO/MARIA
Expires:
06/01/2000
330 E. 291H ST BREMERTN WA 98311
Owner, TACORIO RONAl.00/MARIA
330 E. 29TH ST BREMERTN WA 98313.
Contractor: CDR SERVICE Cu. (,qa- C1r1q 0 360-692-999Lic #: CDRSEC*08206 Exp. 10-24-2000
P.O. BOX 1157 SILVERDALE, WA 98383
Dass: DEMOLITION OF A SHED
Valuation * permit Fees: 6.00 Total Calculated Fee: 10.50
.00 * Plan Check Fees: Additional Fees: .00
x Other Fees: 4.50 Total. Permit Fee: 10.50
This permit shall become null and void if the building or work authorized by this permit is not cco"nced within
180 days from the date of such permit, or if this building or work authnrixed by such permit is .su$Penled or
abandoned at any time after the work is commenced for a period of 190 days.
NOTICE' - - 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
tv borne directly by the oermit 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 wank 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 regulati(\ng construction or the performance of construction.
5ignati.�re: C�,IM,�G�'_ Date
I certify tha am exempt from the requirements of the state contractor's registration law, under
Section 3, ChaptlDr 125, laws of 1967.
Signature:._ ..— _ _ Date:�
Permit Center ---Approved By. +. __ _.___. Date:
E3FRE:ME_FR -F (D FaEF:ZM Z T CE"-rF=FZ
286 4th Street, Bremerton, WA 98387
Phone: ( 360) 478-5275 FAX: ( 360) 478--5278
Building Permit No: 00--0207
Job Address: 330 E 29TH ST Status: ISSUED
Location: Issued: 05/01/2000
Assr Acct No. 3969000--019--0002 Expires= 06/01/2000
R E Q U I R E D I N S P E C T I O N S
Item- 02700 FINAL --BLDG Dept: BLDG Division=
TESTING: Must be recorq(bA1a?ed+96k(he Washington Association of Building Officials
SPECINSP= Must be registered with the Stat; of WA
BLDG.
City
of
Bremerton
Building Department
478-5270,
PLANNING=
City
of
Bremerton
planning Department
478--5275
PUBWORKS:
City
of
Bremerton
Utilities Department
478-5318
FIRE:
City
of
Bremerton
Fire Marshal's Office
478--5380
ENG:
City
of
Bremerton
Engineering Department
478-5270
FIEALTH"
Bremerton/Kitsap
Health Department
478-5235
ST OF WA;
State
of
WA Dept.
of Labor & Industries
478-4921
Permit Hold r'd (1
Signature
r-
4
Date-
11
t
i
4
Date-
11
BREMERTON PERMIT CENTER
PERMIT CONDITIONS
Permit No: 00-0:207 Page: I
?ab Address: 330 E 29TH S'T Applied: 05/01/2000
Assr Acct No: 3969000--019--0002 :;.`' Approved: 05/01/2000
Location: Issued: 05/01/2000
Applicant: TAGORIO RONALDO/MARIA
Owner: TAGORIO RONAL_DO/MARIA
Contractor: CDR SERVICE CO.
Description: _ 0' I c.
DEMOLITION ION OF A SHED
Conditions:
1. ONCE DEMOLITION WORK HAS BEGUN, IT MUST BE COMPLETED AND
READY FOR INSPECTION WITHIN 60 DAYS.
2. ALL PORTIONS OF THE FOUNDATION SHALL BE REMOVED AND
DISPOSED OF AT AN APPROVED LEGAL_ DUMP SITE AND THE SITE
GRADED TO MATCH EXISTING CONTOURS. FILL_ IN EXCESS OF 49
CUBIC YARDS REQUIRES SEPARATE GRADING PERMIT.
3. CONTACT PUGET SOUND AIR POLLUTION CONTROL.. AGENCY AT
1•--800--55'2--3565 ,FOR ASBESTOS REMOVAL INFORMATION. ASBESTOS
MUST BE REMOVED BEFORE DEMOLITION COMMENCES.
4. A RIGHT--OF--WAY PERMIT MUST BE ISSUED IF THE DEMOLITION
PROJECT RE"QUIRE"S ANY WORK IN THE RIGHT-OF-WAY.
THE SHED MUST BE DEMOLISHED AND THE: SITE MUST BE TOTALLY
FREIE OF THE DEBRIS BY 6-1.-00.
Permit 1oId�,
S i . nat�.l F
Date C'
■
RE -1 p I
Iv )r,.;Kx)r,t 1, f. t *T f**Vk*
P i Himber ", (1,00003�,' Amount
os /01/00 il:1*18
fi,.t h�fj: F'A"Ali Notation: t(460RAIO CASH
Init VW
po'I'MO Nw., 00-0,10j, Type: OCHOIANON
PER-mli,
Nc!"
SJ 601 C -19114 ST
�4 "liwil LO. 5C, Total ALL Pod-,
lo . 5o
Hal ;in,,,e
oo
Ac.�;oun( Codf."., Oev rptidn
I rl t
16, iM; 6 OFMOLITTON PUMIT f ft",-,
C.. of)
I J 0 3 6j S W E cif WA, ":,uRCHAPU
APPLICANT: ffOWNER ❑CONTRACTOR ❑OTHER
Site Address: Q -- w 20AMA ST Tax Account Number:
Contractor: G Di ..�'-,nt,r-� I Address:
Contractor License #:
Expiration Date:
Check the tune of annlication annlied for below:
❑ SFR ❑ DUPLEX ❑ MULTI-FAMIL p F /M F (� ' Q
13 MOBILE El ACCESSORY BLDG ❑ RES ADDN !�
❑ RES REM ❑ COMM ADDN ❑ OMM REM
13REPAIR ElSIGN 0 DEMOLITION MAY 01 eiG }
❑ NEW COMM. ❑ TENANT IMPROVEMENT BREMERTON
❑ GRADING (cubic yards: ) ❑ O=R BUILDING DEPARTMENT
Nature of Work Proposed: CJI AzJ yn --VW— C)k V
i , hAu,Y)
Square Footage: Dwelling Garage: Decks
Valuation
P)~an;iReview Fee;:
Pcn;t Fee Surcha esotai
...............................::
Energy: $50.00
State: $ 4.50
l
Applications for which no permit is issued within 180 days following the date of ap fi on shall expire by
limitation, and plans and other data submitted for review may thereafter be ed 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 after expiration, the applicant shall resubmit plans and pay a new
plan review fee.
APPLICANT'S SIGNATURE: DATE: 5 1 U C
Scope
Addres
Owner:
Contras
FOUNDATION
COMMENTS:
FOOTINGS APPROVED:
WALLS APPROVED:
FRAMING
Inspection card/approved plans on site
Insulation: proper fastening
Setbacks
Insulation: vapor barrier
Footings: required steel placement
Walls. required steel placement
Electrical boxes gasketed or caulked
Footings: required width & depth
6 mil black poly in crawl space
Walls. required size
Bearing soil (soils analysis if applicable)
Special inspector (when applicable)
COMMENTS:
FOOTINGS APPROVED:
WALLS APPROVED:
FRAMING
COMMENTS:
APPROVED:
ENERGY CODE COMPLIANCE
Electrical approved
Insulation: proper fastening
Plumbing & mechanical approved
Insulation: vapor barrier
Crawl space access (min. 18 X 24)
Floor joists and beams/proper clearance to earth
Electrical boxes gasketed or caulked
Positive connections posts & beams
6 mil black poly in crawl space
Foundation vents
Posts properly supported
Anchor bolts: nuts & washers in place
Mudsill treated material
Floor joists: size & span
Bearns/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 T
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
COMMENTS:
APPROVED:
ENERGY CODE COMPLIANCE
COMMENTS:
UNDER FLOOR/FOUNDATION INSULATION APPROVED:
WALL INSULATION APPROVED: CEILING INSULATION 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
COMMENTS:
UNDER FLOOR/FOUNDATION INSULATION APPROVED:
WALL INSULATION APPROVED: CEILING INSULATION APPROVED:
MECIMICAL
COMMENTS:
GAS PIPING APPROVED:
OTHER APPLIANCES APPROVED:
PLl1MRING
FURNACE APPROVED:
Appliance location and access, proper support
Appliance clearance to combustibles
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
Woodstoves EPA certified
Woodstoves & fireplaces: Tight -fitting doors
Woodsloves & fireplaces: proper hearth
Manufacturer's specs on site
Chimney liner: when required
Chimney: separate flues when required
COMMENTS:
GAS PIPING APPROVED:
OTHER APPLIANCES APPROVED:
PLl1MRING
FURNACE APPROVED:
COMMENTS:
PLUMBING GROUNDWORK APPROVED:_ PLUMBING ROUGH- IN APPROVED
SI-1FFTR0CK
DWV & water piping under test
DWV: proper grade
DWV: proper sizing
DWV: proper drainage fittings where required
DWV & water piping: proper support
DWV: required cleanouts
-
Vent termination
All fixtures vented properly
Water supply: proper sizing
Shut-off valves on all fixtures
Water heater: 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
Proper indirect wastes: where required
COMMENTS:
PLUMBING GROUNDWORK APPROVED:_ PLUMBING ROUGH- IN APPROVED
SI-1FFTR0CK
COMMENTS:
SHEETROCK APPROVED:
FINAI
Proper fastening: nails -7" o.c. horiz. plane
nails 8" o.c. vertical plane
Proper fastening: screws -12" o.c. horiz. plane (1/2")
screws -12" o.c. horiz. plane (1/2") 24" o.c. framing
Proper fastening: screws -16" o.c. vert. plane (1/2")
screws -12" o.c. vert. plane (1/2") - 24" o.c. framing---- ---
-
Proper fastening screws -12" o.c. horiz. plane (5/8")
screws -12" o.c. horiz. plane (5/8") - 24" o.c. framing
Proper fastening: screws- 16" o.c. vert. plane (5/8")
screws -12" o.c. vert. 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:
FINAI
rnNANAP HTC
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 applicable
Building weathertight
Wood siding to earth separation (6"
Building Address posted
Radon monitor when required
rnNANAP HTC
c
B R E M E R T 0 N B U I L D I N G O F P A R T M F N T
P E R M I T
-.--- -- -- ---- - - ---------------- - ---------- - -- - - -
Council t Census ct
C'onstructioi Sq Feat Inspections
Type & 110,Required
Residence [X] Foundation [
Business Framing [
Other [ ] Insulation [ 1
New [ ] Plumbing
,X]
Repair [ ] Status Mechanical. [X?
Remodel [ ] Code Wallboard [ ]
Addition [ ] Final [X]
---------------------------------------------------------------------------
Received By: Approved By:
ILI
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B R. E M F R T O N B U I L D I N G D F. P A R T M E N T
M E C H A N I C A L P E R M I T A P P L I C A T I O N
Application Number 91AP04492
Contractor NEL-SON'S HEATING
Street 1.723 PENNSYLVANIA
City BREMERTON
Phone (206) 47 WA Zip 98310
Representative JUDY,kMll
State License # N QI*2 x iozi to 06/09/1992
City License # t '1)**,
I14cinera Ir�µl s
A)Aeratio s
Tans
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Application Number 91AP04492
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Application Number 91AP04492
H
RMIT ►PPLIC,A'TI®N
CITY OF BREMERTON BUILDING DEPARTMENT
PHONE: 4778-5281
330 F 2�`,�' Wit- &-a- in,-) 9 3tO
SITE ADDRESS /'\ ASSESSOR'S ACCT.
�45o
.J MAL ADDRESS rP PHONE
CONTRACTOR I I MAIL ACCR=SS v PHCNE J�79 - q 97& L'CENSE .VO.
Class of work NEW F—I ADDITION J- _1 rEF, AIR
MECHANICAL ❑ PLUMBING
i��lu�ii��►j1�
No. Type of Equipment
Fee i No. Type of Fixture or Item Fee
STOVES Gas_ Oil_ Wood_
WATER CLOSET (TOILET)
FIREPLACE INSERT
BATLTLIS
FURNACE Gas (Nat. LPG._ Oil_
LAVATORY (WASH BASIN)
Wood add on_ Other_ Electric_
SHOWER
BTU,57ROC)o
I KITCHEN SINK & DISPOSAL
Type: Up low Down flow_
I DISHWASHER
Horizontal__ Wall_
LAUNDRY TRAY
CONVERSION BURNER: Gas_ (Nat—
LPA
� CLOTHES WASHER
Under 109.000_ Over 100,000_
-- ,, nnry
i WATER HEATER 1-16) �&"
Oil_
URINAL
UNIT HEATER BTU_ Gas_ Elec.—
J
DRINKING FOUNTAIN
BOILER Gas_ Oil_ Electric_
FL -CR - SINK OR DRAIN
Other_ HP_
i
SLOP SINK
GAS SYSTEM Max. 5 outlet Total V
WATER PIPING & TREATING EQUIP.
EVAPORATION COOLERS Roof_ Wall_
WASE = INTERCEr TER (Grease)
BTU
I
VACUUM BREAKERS & BLACKFI OW DEVICE
AC UNIT Electric_ Gas Elec. Combo_
LAWN SPRINKLER SYSTEM
BTU_
I
SWIMMING POOL - Private_ Public_
HEAT PUMP Single Package_ Split_
GRCUNOWORK
Add on_ BTU ion_
SUMP
MIXING OR REHEAT BOX CFM_ BTU_
.ALi RATION
AIR HANDLING UNIT CMF_ BTU_
KICNEY MACHINE
FANS Exhaust_ Supply_ Bath_
RANGE HOOD ResidentialComm.—
PERMIT S
ROOF DRAINS
TOTAL 5
CLOTHES DRYER ,Res._ Comm._
NOTICE
INCINERATOR
i
: HS ?=-Mr BECOMES NW ' AND VCIO IF WORK OR CONSRUCTICN AUTiORIZ=:
ALTERATION 10 DUCT SYSTEM
!S NC-, COMMENCED Wr%i1N ?20 DAYS, OR iF :,ONSTRUC-ION OR WORK IS SUS
?ENDED CR ABANDONED tiR A PERICO OF 120 DAYS AT ANY TIME .4r ER '.vCRK
Heating/Cooiing_ Exhaust_
Is COMME34C=D.
TANKS Cii_ Gas_ Propane w/OK
-E�;E-Y vE,r1FY -!-IAT -+AVE ,=_;D AND EXAMINED 7:=1S .=c .!CA710N ;N
from vire _ect._ Gallons
<NGr. --E SAME TO 3E 7RUE AND _ RRE�" ALL ?Q.OVISIONS ,- -;WS =ND
REFRIGERATION UNIT
CRDINANCEGOVERNING -i!S TYPE CP WORK WILL SE C: MPLc;, '.V1 i
SPEC:= -- 7EREIN OR Nc. THE GRANTING -F A ?ERMIT OOE3 `:GT--E=ijMc
PERMIT S'_
31V=- =U �+ORITY -0 'JICLATE OR C:ANCE:- -HE PROVISIONS C.7
TOTAL '_= J'
A`= = CCAL LAW =+E=ULATiNG --CNS7RIJC:ION OR T}tE
r
..CNS. PUC -CN.
=;NAL APPRCV,L
CONTRA' :0 C.4 AUTHCP;=FD AGENT -_
_-iG:-'A, -_ :° GINNER OF,:wNER BUIL??7
INSPECTION RECORD CARD
CITY OF BREMERTON BUILDING DEPARTMENT
ADDRESS
OWNER
CONTRACTOR
330 EAST 29th
NELSONS HEATING
FOUNDATION
PHONE
PHONE
1
12774
PERMIT NUMBER
1. PERMIT ON SITE 7. CHECK FOR FILL
2. CHECK PLANS TO PERMIT 8. REQUIRED STEEL IN PLACE
3. CHECK SETBACKS 9. (=HECK FIREPLACE FOOTING
4. PROPERTY STAKES 10. ANGOR BOLTS
5. FOOTING WIDTH &. DEPTH 11. FOUNDATION VENTS
b. SOIL BEARING O.K. 12. CRAWL ACCESS
COMMENTS:
FOUNDATION INSPECTION
APPROVED BY:
2A FRAMING
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 CONT.
8. WASHERS ON ANCHOR BOLTS
9. BEAMS PROPER SIZE
10. FLOOR JOIST SPAN
11. NOTCHING & DRILLING
12. STAIRS
WIDTH
RISE & RUN
WINDERS
LANDINGS
HEADROOM
13. ATTIC VENTILATION (upper & lower')
14. CHIMNEY STRAPS SECURED
15. FIREPLACE COMBUSTION AIR
16. FANS VENTED TO OUTSIDE
17. WATER CLOSET CLEARANCE
18. SMOKE DETECTOR
20. FIREBUDCKING
STAIRS
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 CLASS
SAFETY GLAZING
REQUIRED FIRE EXITS
WINDOW SILL HEIGHT
22. CEILING HEIGHTS
23. SWAY BRACING
24. TRUSSES
PROPERLY INSTALLED
STAMPED
PROPERLY BRACED
25. ATTIC ACCESS
26. *RAFTER & JOIST SPAN
27. ROOFING, FLASHING, SHEATHING
28. SIDING;
19. SHEETROCK BACKING COMMENTS:
UNDER STAIRS
ABOVE GARAGE DOOR HANGERS
FRAMING INSPECTION
APPROVED BY:
2B INSULATION
1. PROPER R -VALUE
2. VAPOR BARRIER
3. PROPER FASTENING
INSULATION INSPECTION
APPROVED BY:
COMMENTS:
MECHANICAL
1. PERMIT ISSUED
2. FURNACE LOCATIi )N
3. FURNACE CLEARANCE
4. 'B' VENT SIZING
5.'B' VENT CLEARANCE
6. 'B' VENT SUPPC )RT
7. COMBUSTION AIR
8. DUCT SIZING
9. DUCT SUPPORT & JOINTS
10.GAS PIPING TEST
11. GAS PIPE SIZING
12. GAS PIPE SUPPORT
COMMENTS:
PLUMBING
1. PERMIT ISSUED
2. UNDER TEST
3. WATER PIPE SIZING
4. DWV SIZING
5. PROPER SUPPORT
COMMENTS:
UNDERGROUND APPROVED
BY;
q WALLBOARD
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;
FINAL
1. HANDRAILS
2. GUARDRAILS
HEIGHT
INTERMEDIATE
3. EXHAUST FANS
4. WATERPROOFING IN SHOWERS
5. DISHWASHER AIRGAP
6. FIRE DOORS
LABLED AS REQUIRED
SELF :.LOSING
7. FIRE DAMPERS INSTALLED
8. PENETRATIONS IN FIRE WALLS
HVAC APPROVED BY,
GAS PIPING APPROVED BY. 2"�4g'
ST
1. WOOD STOVE CLEARANCE
2. CHIIANEY CLEARANCE
3. HEARTH EXTENSION
4. CHifyiNEY HEIGHT
VVDST APPROVED BY;
6. PROPER FITTINGS
7. REQUIRED CLEANOUTS
8. PROPER GRADE
9. HWr PRES. RELIEF VALVE & LINE
10. SEISMIC STRAP
ROUGH -IN APPROVED
BY;
6. FIRE SEPARATION IN GARAGE
7. ATTIC ACCESS
8. DRAFT STOP IN ATTIC
9. PROPER CONST. OF FIRE WALLS
10. DROP CEILING & LIGHTING
9. HOT WATER TANK PRL
_11-C UTEZE GRADE --
11. SOIL TO SIDING CLEARANCE
12. SMOKE DETECTORS
13. FIREPLACE HEARTH
'14. SAFETY GLAZING
15. INSULATION
WINDOWS MEET ENERGY CODE
UNDERFLOOR & ATTICE INSUL.
WATER PIPE & HEAT DUCTS
16. WOODSTOVE APPROVED
17. WINDOWS & DOORS CAULKED
FINAL PLMB, APPR, (comm.)_ COMMENTS:
FINAL MECH, APPR. (comm.
FINAL BUILDING APPR.
I
r.
Nn 3'719 4 Fee $--- /---- ------------------------------------------------------ Receipt No..------
BUILDING PERMIT
CITY OF BREMERTON - BUILDING DEPARTMENT
F. E. IRISH, Building Inspector • ESsex 3-1411, Ext. 36
Owner's Value I Bldg. Dept. Value I DESCRIPTION:
3 ? 0 O Lot Block Additions
Addresson Job --------�'--------------------------------------------------------------------------------------- V ----------- '3 --- 196....
Building ---------------- x ---------------- and ---------------- stories ------------------------ baseme------- x ----------------
FrontYard ------------------------ Rear Yard ------------------------ Side Yard------------------------------------------------
Occu anc -----------------------------
Owner---------------------------------------------------------------------------- Address -------------------------------------------- Phone ----------------
Contractor------------------------------------------------------------------- Address -------------------------------------------- Phone ----------------
This permit is issued for:
----------------------------------------------------------------------------------------•-----------------------
------------------
-----------------------------------------------
r-_ 1
----------------------------------------------------------------------------------------------------------------,----------------------------------------------
-------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------
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
BuildingInspector ----------------------------------------------------------------------------------------
oRBy---------------------------------------------------------------------------------------
TY OF BREMERTON BUSH
Tax & License Division ® 239 Ott' Street •
Office Use Only
Receipt # Initial ZVP
O/
Fee Due: t�� ($65.00/annual) Initial
Business Name:
Business Address: 3,30 -EF- 94+1'10f %- - e>R-V-"
City/State: WA Zip Code: q R,3 1 0
-ICENSE APPLICAT��I,,
C. E' j *V98 t7 fV60-473,_
JAN 2 12004 14
License #
A I C C Issued:
Ownerer N� W—fWS./dr CS` -I
0? -I U
Home Address: —33b — t7 t5TI �✓�
City/State: 291FIAO-TA ON V3/'%- 3i
Tax Returns Mailed To: St'kM m:> Aoc) %I
Date Business Started in City: Business Phone: 310 D 13 3 5 Home Phone: ]CA —S(p %�j
Nature of Business: i ��%► �� ^
(Designate whether Retail, Wholesale, Manufacturing.Aervice, etc., and spec y Product or Service pro��ded)
Type of Ownership: Sole Owner ❑ Partnership ia-1, Corporation ❑ WA State Tax / UBI Number:
.O /yJt. 10
Name / Address / Phone Numbers of Partners or Owners of the Corporation: 3 t4 w _ ��'�' A 0010
4-nnb— AS `� `(
Will there be remodeling or altering of an existing building for your business? Yes ❑ No 0 Number of Employees:
,:P-
If you are tenant, give property owner's name: Business Square Footage:
Is this tenant space currently vacant? Yes ❑ No ff"- If No, Explain: VVQ M W Office: 5 �S
Will you be sharing this tenant space with another business? Yes ❑ No E!r- If Yes, Who? Retail:
Will you operate this business out of your home? Yes Er- No ❑ Other:
If yes, will any person be employed at the home other than resident? Yes ❑ No Rr
If Home Occupation, I have read and agree to abide by the Home Occupation Regulations found in the Bremerton Zoning Ordinance: Yes k -No ❑
PERSONAL DATA REQUIRED OF ALL APPLICANTS
(If Corporation, an Officer must complete this portion)
3irthdate: 9-11 '(P 02 Soc Sec Number: ;)-3 O^ �1 —45 C1 7 C.A S l 11-A 3 8 S' State:
IlL Numher: -- -- - ( 1✓�
1,D lv z 557 D'j'�rota _
Ile uudersig ted 1 rebs certifies that the infonnation provided nit this application is true and correct, to tlrc est of Itis f her knowledge rtttder �e talty of
lerjury tinder the hars of the State of 14'ashington:
'rint Full Name: j i? 5� ESTI L -LO Title: QWIJ 6'Q. - Si -nature:. �� 16�V—
14 - _l -- t'A-tiro R i 6
DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED
............................................................................................................................................................................
)FFICE USE ONLY
_Pmart-e•
DCD INFORMATION
Type of Occupancy Occupant
Construct Classific. Load
r 8
zo b16,43d1 2 i 100
"•':'fI EMEKON
31111 DING DFPARTP `
BUS ID #�
PROP ID #
I-
SS t.�Z j aV i (fit t EM � DSI tAC J f
---------------------------------------- Receipt No. ---------V- 2-- ---------------------
Permit No. — Fee P /,1
APPLICATION FOR BUILDING PERMIT
CITY OF BREMERTON — DEPARTMENT OF BUILDINGS
Owner's Value
Bldg. Dept. Value
Class of Constr'n
Fire Dist.
Use Dist.
Area Dist.
Height Dist.
Plans Filed
YES NO
LIFE OF
PERMIT
Address on Job .3Q. --__F _vet, ----------------on Lot _ Bloc -------- Ition
Building --- �--- X - -- - and - stories- ------------------------ basement. Lot ---
Front Yard ____sa_----------- Rear Yard --------------- Side Yard Garage --------------------------------
Occupancy---------------------- ------- ----------- --------------------------------------------------------------------------------------
Application made !2 _'- .l - - 195.E Approved --------------------------------------------------- 19 --------
Permission is hereby given to do the work described below, according to the conditions hereon and according to the approved
plans and specifications pertaining thereto, subject to compliance with Ordinance No. 2173 of the City of Bremerton.
INSPECTION — Reinforcing steel must be inspected after placing and before covering. FORMS shall be in-
spected and approved before pouring. All plumbing, wiring and the frame of all buildings must be inspected
and approved before covering.
BLIILDIN A,WS:�Be sure you��e informed of the building laws before beginning work.
Ownerr ��iftJi ..--�c7L� Address Phone
Contractor-------------------------------------------------------------------------------- Address ---------------------------------------------------- Phone--------------------
Architect----------------------------------------------------------------------------------Address---------------------------------------------------- Phone --------------------
APPLICATION is hereby made for permit to do the following work:
---------------------
--------------------------------------------------------
---------- �-'� -
---- - ------------------------------------------------------------------------------------------ -------------------
--- - ----------------------- --
------------------ 1i.�( - ---- ----- G =
-----------------------.�c__ �'`--- _ �'r�a,�.� � mss:. --------------- - ----- -- ------
-----
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Owner's Signature---------•-----••----------------------------------------------- By ----------------------------------------------------------- .---------------•------------
His Authorize A ent
Building Inspector----- --` .........
* --9---------------------------------------
By-------------•---------•--------------------------------•----------------......, .