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HomeMy WebLinkAboutPACIFIC AVE, 412V B Ft 4 2? M E R T Q N B U I L u x N G I F t� A R T n] F N T ApplicatioXa Date b4/27/1995 Applir.ation Number 95AP086-B Issue Date 04/27/1995 Permit NumbAr 1.6292 Assessor Acct # Project Group Site Location 414 PACIFIC ©wrier - Vast Name BURNETT First AMX MI Street 412 PACIFIC City BREMERTON State WA Zip 98337 Phone (360) 373-3187 Tenant's Name Phone(206) - Agent's Name Phone(206) - Architect's Name [X] Building [ ] Grading [ ] Sign [ ] Paving ] Mechanical [ ] Move Building ( ] F.urning [ ] underground [ ] Plumbing [ ] Mobile Home [ ] Land Clear [ ] Demolition Building'Contractor; Work will be completed by owner, }� qq�v Nature of. Work. Replace windows.....must be U value of .90 or less and window glass must be safety glazed. q� One window beincharged to City ( _g g x of Bremerton) Building Valuation $�.000.00 Council District 4 Census Tract Construction Type Sq Feet Inspections Required Residence [ ] Zoning Foundation [ ] Business [X] Type Framing [ ] Other [ ] Insulation [ ] New [ ] Pl urribi.ng Repair [ ] Status Mechanical ( ] Remodel. [ ] Code Wallboard" [ ] Addition [ ]- 12 Final [X] Received By. A oved By. `l This permit shall become null and void if the building or work authorized by this permit is n,ot commenced within 180 days from the date of such permit, or if this building or work authorized by such permit is suspended or abandoned at any time after the work is cammencerl for a period of 180 days. NOTICE - It is the responsibility of the permit holder, not the City of Bremertoa or Building Official to see to it that the required inspections are made. The permit holder must notify the Building Official when ready for the 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 be borne directly by the permit holder. Failure to substantiate code requiremenu will indemnify the City against any and all responsibiliry 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 the provisions of any • the performance of construction. d% �'� Date I certify that I am exempt from the requirements of the state contractor's registration law, under Sec. 3, Chap. 126, laws of 1967. Signature �� Date Permit Number !i F Is: M W R ')' C N t? I I ). ! f N i W !' A P T M H' NF 4' RROFfPT # (0)884`)I * TF,i i:' Nnt A Ppt.mit * Af,; I, 11414ti F>Nrmi t FPA I!mrilmf Pa i (t PI -in ('.heclt FPP:f AITW)1.}11t Pf;) R(j.i i(ti1w)c7 c 2Lj,(Io .00 MPchani rya 1 $ . 00 fi f)U 111.1 )amhi ng O0 $ Oo h? "i45.8:30 C)t.lie r F'pP�; 71on.j ))(I OF PPc r)t h(m r F'Pen $ t 00 t y S))r C haysge$ 5 .00 H I.-"i?? . [009 Statp S/C 4. ta I F PPS: 1�n Amnuutt. Pai.ri $ 34 . SO Pri nr Paymel)t $ 00 Pa 1 arjr,,e ])Ile' $ Of) Rereivpd From: rm O4 j :j7/ 1.99 Amy R)jr•nPt t #"i14'1 rnr V15AP086.1 I r- C B R E im F R a O N B U I L D I N G Application Date r4/12/1993 Issue Date 04/12/1995 Assessor Acct # Site Location 41.2 PACIFIC Owner. - Last Name BURNETT _. Street 412 PACIFIC City BREMERTON Phone (2.06) 373-3187 Tenant's Name Agent's Name Architect's Name [X] Building [ Grading [ ] Mechanical [ a Move Building [ ] Plumbing [ ] Mobile Nome Building Contra!�t.or: Work wi;. l be compl etect by owner. D F. P A R T M PI; N `C Application Number 95AP08572 Permit Number 16256 Project Group First AMy' MI State WA 7_,i_p 9$31.0 Phone(2U6} - Phone(206) [ Burning [ Underground [ 7 Land Clear [ ] Demolitiozl Nature of Work: Change out windows on front of. business. Glass with safety glazing, double payned, Building Valuation $3000.00 Council District 4 Census Tract Construction Type R�S:1.G'�@nCe BiXB�.ne�S Other New Repair Remodel Addition Received Bvf J Sq Feet Inspections ReguiT�ed [ � 7vni.ng Foundation [ ] [�� Type la'rami.n.g [ 1 [. ] T.nsulation [ [ Plumbing [ ] Status Mechanical. [ ( Code Wallboard [ 1 1 .1.2 Final [X] Approved By. REt' E: T. ►''' ! 1i u 1 ,I. d i ra g ti?—:3�7. LUf17 St'r�rz Adapter LF,--:34L.5UUU l•c�p:l E3Pi rifli7Y? 1,i.11� �F:PA {?E?3�1117 t, �F�`� Aillntallt- 1�rl 1 + y �• I •�r� ;'f,F-.r•1r f� P� ^ A�trli��ti i �-� i �i 0 oul Amv 9m nfAt t # 11.43 ►�ri nr )�aYm�nt $ , r10 �`ilr #`�tiAF'UH ;72 APPLICANT:El OWNERF'j CONTRACTOR Fj OTHER: , 7 CONTRACTOR LICENSE # CONTACT TAX ACCOUNT NO. ADDRESS: ADDRESS: EXPIRATION DA' PERSON: l %v &/ CONTACT PHONE # SFR � DUPLEX � MULTI -FAMILY � BUSINESS � OTHER: SIGN DEMO MOVE BLDG. MOBILE GRADINQyds): NEW MREPAIR REMODEL ADDITION F1 OTHER: NATURE OF WORK PROPOSED SQUARE FOOTAGE: Dwelling: Garage: Decks: 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 applicant 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 Wiration, the applicant shall resubmit plans and pay a new plan review fee. APPLICANT'S SIGNA This permit shall I=ome 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 abandoned at any time after the work is commenced for a period of 180 days. NOTICE = It is the responsibility of the permit holder, not the City of Bremer ton or Building Official to see to it that the required inspections are made. The permit holder must notify the Building Official when ready for the 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 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 certir"y 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 goartting of a permit does not presume to give authority to violate or cancel the provisions of any other o local law regulating construction or the performance of construction. so ig ature D I certify that I am exempt from the requirements of the state contractor's registration law, under Sec. 3, Chap. 126, laws of 1967. Signature Date Permit Number 1 �, �1 _, f� LL C` � W � o �J �� -- --�--- �- d��. \� � j �, � � ' '�. �_, �, � __ n I� n �� ��� � _ � o �, , � \ -- .._- � '� ,. �, r- �. �` ��� � - -- .� `\ �.. ,, \ t+� r-��- _ Q � '�,, � C � ,., \ -- ��\ ���� ___ \\ \ ,, ��, '\ Z - - ��\ ,\ � - � . � �� �`�. 2 . ��� Z � --- - � Z ,- �` G1 M - -- - r-. c-� I W�- 3 0 NI M I M M 1 1 i i s 1 f 1 1 ■ 1 l _ 7 i _ 1 1 _ 1 _ / Q wQ 1�1 • r i 1 � _ ' 1 � i _ .� i 1 l _ 1 i ' 1 _ _ t - i 1 ., - _ j � 1' _ ' i ` _ 1 1 � i � _ 1 1 � _ I' , - i � 1 _ � j 1 1 i 1 _ _ - - 1 . � � � - - - ` i � _ _ :� - _ _ 1 1 i 1 _ _ - - �� .� ; j _ i - - 7 ` _ i 1 1 i 1 � _1 i � _ _ 1 _ _ 1 1 1 � ■ _ � ,1 . 1 1 _ _ � � _ ; _ 7 _ _ r °x d 0 V pra A O V i I _ 1 ,r. • 1 i 1 1 � _ , A a O U" U A a a z 0 F-1 o z o N IllY.0OY1 .� 0 QQJJ V •• •a � V .� Ir lr i •�• VVjj pp qqq qq 5 O g v, 'S7 4 Alm �MW ow c o 4 $ 0 'a �•p �� ��w�S � As " � a w .. O C d»Ac7c7c7��U i - 1 i .1 1 _ _ f 1 _ 7 S a - S i T 1 F, s d d N N N OC ` L 00 0 ~ ;uq• *�Q :7 N t4 t C N N N N on N nM 1�1 rl �F•1 Vi rl 00 ow O X f J t) c Wl ow � Al b Q � U w w i 1 / .i i 1 1 1 - i 1 ; i - i B R E M E R T O N App.Licat.i.on 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 B U I L" I N G P E R .M I T O1/05/1994 01/05/1,994 3 7V Ado6 - 0ad -d 003 4.1. _ PACIFIC AVENUE BURNETT 412. PACIFIC AVENUE BREMERTON ( 206 ) 373-31.87 D E P A R T M E N T Application Number 94AP07248 Permi.t Number 1.5172 Project Group Fi. rst AMY MI State WA Zip 98310 Phone(206) - Phone(206) - [ ] Grading. [ ] Sign [ ] Paving [ ] Move Building [ ] Burning [ ] Underground ] Mobile Home [ ] Land6Clear [ ] Demolition Building Cant.r.actar: Work will be completed by owner. Nature of Work: Replace store front windows on south side tjf bung. Windows to be minimum double glazed. with 1/2" minimum air space. Safety glazed. Building Valuation $4000.00 Council District Census Tract Construction Type Residence [ ] Business [X] Other [ ] New [ ] Repair [ ] Remodel [X] Addition [ J. Received By,: Sq Feet Inspecti ons Required Zoning Foundation [ ] Type Framing [X] Insul-ation [ ] Plumbing [ ] Status Mechanical [ ] Code Wallboard [ ] 12 Final [X] f Approved Bye rr 'T'fll t, { i4i'tt A tit 1";717 t ►,-,r j'.'):f a K.4 Ilil c}atI0 . nn 3 7J Q-G6 - 0C) Inrli;ic� I R�•r�-'1 sari Ft r;m' Mr1Y iirl (tf?tl F It t 4 f ') 11ti)tIkI f;Pil 1';iyrnF�•;lt z, .j c,ti hrrlrlllrt t }';t i c? tit: iot P )Nimel(if; `� • �. s i APPLICANT: ® OWNER Lj CONTRACTOR Lj OTHER: SITE ADDRESS:`;1-I� OWNER: Amy 9URti C-rr CONTRACTOR: O (.cJ N E✓ CONTRACTOR LICENSE # COUNTY ASSESSOR PARCEL #: ADDRESS: ADDRESS: EXPIRATION DATE: CONTACT PERSON: rtY CONTACT PHONE # SFR � DUPLEX � MULTI -FAMILY � BUSINESS � OTHER: SIGN DEMO MOVE BLDG. MOBILE GRADING(yds): NEW REPAIR REMODEL ADDITION OTHER: INTENDED NATURE OF WORK PROPOSED: ING CLASSIFICATION: COUNCIL DISTRICT: SQUARE FOOTAGE: Dwelling: Gatage: Decks: For Department Use Only 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 applicant 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. I hereby certify that the above information is correct to the best of my knowledge. APPLICANT'S SIGNA DATE,• N rl to r-1 N 1 7 1 1 i 1 f 1 1 i i 1 i _ i � i 1 � i 1 � i 1 i .` _ i 1 - - 1 1 _ 1 :1 s / / i { _ 1 � 1 T .� 1 1 i i � 1 - _1 � 1 i I I _ 1 j j f _ _ ; _ 1 1 ' . . 7 � � - - -1 - _ - � � � 't 1 i 1 - 1 � •� 1 j_ i � _ 1 i - 1 1 � • 1 _ I -1 i .r � - _ - _ _ - _ I 1 � � J 1 � 1 � _ � � 1 - _ f _ � � _ � 1 � ' a � .. � A �+ �+ d 7 .. i 1 1 i 1 i l A O a a O A O z i -d � -d � � �,� � .a N � p C � � � E N ' �, '� 0 0 'd � � ° � � � a E � � � � w ;� CC m ro as •a�s.�•��as °� � •� 'a � �S � � .. . �,, � � � N a �C7C7C7C���U d� � -� vi .d ~ o a dl V � �(i � � � ►. •� � 5•i4,i yy � ° 4 4°I ° C .� � •a° °' � w aS •� .. •� _ ... « �'� � a C d»A�c7C7��U a a a a i i i i i :� _ � i _ _ '' •' _ .r .� _ _ �� , ` _ _ i � .1 y s � � � _ i j .1 :r 7 � .1 a - 1 .1 t' �' .. � _ ���� s d d •�� d N N N C � � .—. � N i oo co Q ..��.., 3 � {� ��� a� �i u S �i '� � d d d d ,�y O N N N N» a� .,�.,.. a O l��Jy %1 Vl A jy��ti N �� N o`o � ��v" .� .��� N N •O •� •[ � � f � .rI tj GS � t ,� o ° o d °° o N � ` � ` ;� o •a � � ....� •� A � ������"� � G pU� od w i i i � .i ; — - i _ - � -' , _ . _ _ �, - r i i T i 1 _ _ - i 1 � T _ i _ _ �. T' - - � CERTIFICATE OF OCCUPANCY CITY OF BREMERTON r_ BUILDING DEPARTMENT °Jftia & j""6ii LOVE 1N ' LIVING COLOR �acc� Ced aC 412 Pacific I ce2l� Cl:at-Clie a� yrcuv� sae �s,�aiCii ice jricaraiaiayca a�Giie °�iu�r�vn� X40"w,4" a / TYPE TYPE OCCUPANCY CONSTRUCTION OCCUPANCY LOAD COMMON USE - VN B2 8 Florist kale: �i��ced• February 17, 1993 °WOW4&W �� David A. Nelson This certificate must be posted and permanently maintained in a conspicuous place. Permit No. Bus, Lic . g'iLq D k 8 8)) M 8)) M M 8 1 M P)) 8)) M 8)) M 8)) q 8))M City of Bremerton, Washington Phone: (2O6) 47H-5Z81 ASSESSOR'S ACCOUNT NO. � �� SITE ADDRESS/LOCATION 402/412 Pacific Ave. e,�1.(L.(, �,.$ • •� • ►�• ti• • •� �' • - OWNER'S SIGNATURE BY Agent (SEE AND READ NOTICE ON REVERSE SIDE) ��®C�� ❑ RESIDENCEBUSINESS ❑OTHER ❑ 'NEW REPAIR " ❑ REMODEL ❑ .ADDITION ❑DEMOLISH ❑ SIGNS PLANNING/ZONING #STORIES OCCUPANCY THIS PERMIT ISSUED FOR: Re —roofing 62 Squares Type A Hot Mop 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 the provisions of any other state or local law regulating construction or the performance of construction. INSPECTIONS REQUIRED: Foundation ❑ Framing ❑ Plumbing ❑ .Mechanical ❑ Wallboard ❑ FINAL OWNER OR BUILDER SHALL CALL FOR ALL REQUIRED INSPECTIONS AND RECEIVE APPROVAL PRIOR TO CONTINUING WORK. SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING AND MECHANICAL. COMMENTS: STATE SURCHARGE $ 1.50 (All) ENERGY CHARGE $10.00 / 15.00 ���- . ti _ BUILDING OFFICIA�`� �,,�,�� � ��..� o VALUATION $ 7,874.00 PLAN CHECK FEE $ 0 RECEIPT NO. PERMIT FEE $ 99.00 RECEIPT NO. 76013 DATE 8-29-86 BUILDING INSPECTION DIVISION — Bremerton, WA 98310 Permit No. r 7 5 3 9 —� COPIES TO: WHITE -BUILDING, YELLOW -ASSESSOR, PINK -OWNER t hiii pc l-mii sheall becollic null Auld void, it Ow bmid'Wril Ma V=d)tI. <Itthol iz(^dl by Ilii�, �:�I�Idiit is llt>t ciooY(I ocd,dl within IRO Mys, from (lt£A daic «t sup 11 l)c.rttnit, or if illis building ol) v.ultk tsinhori�7d.tl by ;itch pull Sit i:, suspended ot, ;liriir)£iol- d, elt am iitrtd ti(lt;tdic k ock if; s't,itt Ittct)c:csl tM is pkd' iod of U,110 days, 1 heleby ccldi'v i1mi I licelve lvri l all(] £,;;amioc£1 ilti;i ijjplicf)Oolt nmd I'lld)w dw ;dlwc it) bC fl lw ,tart coj.A4cc.l, All pr ovic,iows of k0ws, aiicl 011lirditl d € s crow/wilt}; ti)i i t vlte ol d.doCk �v ll tY(', compti €1 With S"Ill£'C'i�,t ,;Y�',Ct It"i iti'CL'lit dlf not,�� he ontut-ifiv o it (3d font Cims not l�icslan v toJvc, flwll€ ri� y to viol.ow P)}'. t;.ciTICCf 016 pt`ovisioll'4 of ell]y d}ihC� ()ILf 1. l<r��' (ci,�i lflti tP ("oosinwlioll or the 1wflolt3h ice of £;ow;itilC;l'.3£)7L t cclid"y that t.am £'xct)O 1row thl7 TCS 'S ti�„�,1.`,tdlltir}li law Mtdl(iT ;,r�. t, Chidt , Ii w(W 1967, .. 7 N p Ail NJ, A. i. t t)t1[tdht(i£.a13. 6,d�fd>,<. t,i<Id;clnc°rat dal £�d>ti£.�tiic /. , C�)Itw tlr.t€ i . %'OVLd �1111 T ii6MOV Wills arldt diel aII Iduinti6 , iiltS tefl{t 'r 1, £ t='., M�C 1ti i;( llcdl nod dttrt)rcsl. ,, sv. lll(,mif l or klih below 1'itiir,lliagt i t'3#ftll, 4 iPt r S'o111(ilf'iit731 itikil 13d, t'f7t'e s)6;d.;#i 17F![It'}%. li-z.,) d Id 91x)Il,:it 4lidy tai 9h£: I;,�rid�it 1)£)Id de IIoi I11c � "ity o1 f,II lItdttix)n car P%clildii)tF;' ltiicittl s�) ;+��c to €i Owl ilid; it°£J31i3d;cl ill>i,clitio,l„ rlt� hatitdld;. `I'ltd; li,;)illii ho1dld,)� l� u'A notify iltdi fluddtitt}', {3(d,d i,t1 kavph ll ct;il£Iv [(ii'Ow iw-%(wc[Idat ;. i nilm,V 01 [Ix;1w ill t Iio l(ki to tld)ii[4x tid, 4i llaliil;�=, i[itri4at (lint. (;oIt,,i+tIcttoII lids CotlI dil:I)k t(i a poijile ilwi t,i;ladOloll a, iq trrdlpaliF: Sd�, ll Edi vc illti City of iti�cittr;tioll of emY sirl£i t;lt rc:;f)oll,;il)Ilit.v 16 v tI lo iwt llilwl 61 q' hic h £ i},141 :'fhociloo is t;diifctts)tctl. OWNER'S NAME ,�12 i,u� OWNER'S ADDRESS �� _ �, P PHONE���-,�„�'�., CONTRACTOR j��. �' F 5��t/�C� f.�� STATE CONTRACTOR'S LIC. # F� - ,�' C _ �/� - 5�(,,� L f ADDRESS ,���jo}� ��,�' 1,�f ��� �. ��v, �j'�'d.';t PHONE �7 j_ �r��`r✓ ISSUANCE OF OCCUPANCY CERTIFICATE REQUIRED BEFORE OCCUPYING BUILDING OWNER'S SIGNATURE ❑ RESIDENCE -� BUSINESS PLANNING/ZONING THIS PERMIT ISSUED FOR: ■. # STORIES Agent OCCUPANCY ❑ DEMOLISH ❑ SIGNS 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 the provisions of any other state or local law regulating construction or the performance of construction. OWNER OR BUILDER SHALL CALL FOR ALL REQUIRED INSPECTIONS AND RECEIVE APPROVAL PRIOR TO CONTINUING WORK. SEPARATE PERMITS ARE`REQUIRED (WHERE APPLICABLE) FOUR PLUMBING, MECHANICAL AND IELECTRICAL. �j COMMENTS: / ,�dt� .��: _ 1Gf� k5 � I� �(�'�" IM ('� P /`.f (�� �1, I t-- � -- rr-� S+,l I� V L ..., j$ y i. j � i 1 �. 1� .. �. 1,. BUILDING OFFICIAL: VALUATION PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. DATE BUILDING INSPECTION DIVISION — PACIFIC, Bremerton, W Z 3 0 e, v rn M Lll O W W V m W Cl)o V>= Z� W m Z H W a N 0 U W r 0 W p p ¢ 0 r C7 H U Z 2 v g o~ cn or M6 ZO �w d cn 2 w W F- U °�Y°�JWg�gWQ �2g9NOu..twOZZU ZOa.wW F>— l2i�OO� F-`1`1 W ZCn eEYeo p--1 U U W H � U 2 U 2 Z Z 2 W W O O J W O W U D D ¢ W22Cr0¢2WSZOO2 U U a. 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BUIL®ING PERMIT CITY OF BREMERTON BUILDING DEPARTMENT F. E. IRISH, Building Inspector • ESsex 3-1411, Ext• 36 Bldg, Dept. Value DESCRIPTION: Lot Address on Job Date ---------- ------------------------- Building Y and ------ stories basement. Lot .---- ---- 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 Block 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 Aulhorized Agent Building Inspector ------------ ----------- of BY ------ ------