HomeMy WebLinkAboutAlteration Permit #95537,94741 #313 - BLD Permit / Conditions - 6/30/1998 Department of Labor&Industries ALTERATION PERMIT
Factory Assembled Structures Section _ Do not complete shaded areas
INSTRUCTIONS: emtrt 7. A
1. Complete all spaces,including the signature box(marked with an X). Invrnoe �}
2. Draw a map on reverse side of WHITE copy only. O
3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.OA-ne Jta3��rua
r last name first name Da time phone Date
0 T R lice a .20/s 1-ems-
Address City State ZIP
90 �0313 6LE4// A) 'SfiE- G11A)
G(/fr 9SS��
Installer/Contrac /Dealer Phone Contractors registration number
(n�ti ,�A-4tA 0-4 At' - 040) ya 0 S
Address City
� O 1 EUTA/S A" /J Si E L-7bA) , A State �ty
Check the appropriate boxes in section A and section B. FEES
A ❑ Commercial Coach B ❑ Alteration Inspection(check appropriate boxes below) $ �J j�, �
Air Conditioning/Heat Pump �—
Seria!No. Electrical
Electrical Appliances
Mobile Home Fire Safety Tras ID 98564769
Serial No. Gas Furnace 03/2-5/19% 15:24
/ 0 as Piping Currency : $78.00
liuD No. Plumbing
Structural
Wood/Pellet Stove— — Serial a
Recreational Vehicle or Park Trailer .
Serial No. Plan Review — —— —— _ — —— —— —— — —. $
RV Inspection — —— — — — — —— — $
Model No.or Plan Approval No. Reinspection— —— �� etntu
Technical Inspection — No— `— —— — — — - $
Signature o 1 t or au ri presentaeive Make check payable to: Dept.of Labor&Industries
X FEES DUE $
Department use only
Request approved or ❑ Request denied because oP specific violatinnb of Washington rules and regulations. Violatlons must
be corrected and rehispectbn requested ivit6ln IO days#or tectlt tlbti�tl vehicles nttd xtt day3 b tnoDlk hotue tthd commerclai cW.
of the notice of violation date. (This does not apply to techWcal tnspectbus) It.Js unlat�rhtl to olr tar sale,rent, or lease any
non-coact 1 i mobile home,commercial coach or tecre$tbbal vehl+cle.
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Included are forms required which must be completed feet sttbih before re inspection
Date Area office Jmpectot Total pages
P622-012-000 alteration permit 11-97 White-Olympia Green-Contract3r Canary-Inspector Pink-Purchaser Goldenrod-Purchaser
Department ss of Labor&Industries ALTERATION PERMIT
FactoryctotyAssembled Structures Section _ Do not complete shaded areas
INSTRUCTIONS: milt
1. Complete all spaces,including the signature box(marked with an X). Invoioc
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fees to the nearest L&I office. See list on reverse. _
4. Contact and schedule the inspection with the same L&I office within 15 days.Owpq insignia#
last name Oft name 1 time _ . Date�..y_.:___
Ad4ress City S ZIP
Installer/Cantractor/Dealer
Phone Contractors registration number
Address
City State ZIP+4
Check the appropriate boxes in section A and sectioe B.
A B Alteration In tion check ro riate boxes below) $ 1
Commercial Coach � • aPP P
Air Conditioning/Heat Pump
Electrical Trans IP : 98649023
Electrical Appliances 06J30l1998 15:54
Mobile Home Fire Safety currency $81.00
Na Gas Furnace
16
Gas Piping
Plumbing
Structural
Lj Recreational Vehicle or ❑ Park Trailer
Wood/Pellet Stove—
SenalNo. Plan Review — —— —— _ _ _
RV Inspection — ——— _ ——
Model No.or Pian Amxnval NN® Reinspection— — — e+Qast.
Technical Inspection —- — _— —— —� $
Signature leant or authori presentative Make check payable to: Dept.of Labor&Industries
X FEES DUE $ X1, 4
RegnPl+ of Itegnestdenied tiecattse of speciPCc vbWtbes of Wns)sington rules regplattitms Vblatbns must
1ff tmd rei11` t1it_)tit+,yb lei'ti`lyEif01kM1>Yeltbtl ....:. ..:: .. ., ............:..,: >:;'.
of t>b�bocce of vlolatlon ate: tot�idM+ilk tiif�u�m4rerclnl boi+cbes.:
tig moM,tk b � aPPXY to ltecbnssprcttonj. It is uelaafitt#o'i�Cler fir tale,rent, orlease any
..
nokiotn o1a ;:,erllaetifla rnr l�rekt,�l wrlcle.
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`ycy �f iwt � � J y /`Y �• +°✓\+I f (///{} �/ /�//'}.,yyJ��/y..y.'..�.. 8- Y.s�,e . .. . .
y if•.w,yti'.;+'•/l:•"h:
* 71t '� aRld��4ttbmlttsd befo�p�eiltspet�ttora.
Area �,
Total ga
F622-0124M shwation permit i t -, Whit-Olympia
Green-Cantrac or Cana - apeaor Pink-Purchaser Goldenrod-I'orchaser