HomeMy WebLinkAboutAlteration Permit #9567 - BLD Permit / Conditions Department of Labor&Industries f
Factory Assembled Structures Section ALTERAT 6N PERMIT
Do not com l d ar
ete shadeeas
INSTRUCTIONS: emtit 4
1. Complete all spaces to and including the box with the signature X in it.
2. Then draw map on reverse side of WHITE copy only. Invoice#
3. Submit completed permit and fee to the nearest office listed on the back.
4. Contact and schedule the inspection with the office in which you submitted the Per It, ,.;: Insignia#
within 15 days r 1 1
Owner last name first name Day time phone r;
Address��.............................................. ......................!.......... ..........................._.... .1 �'..��......................'..............:................ :'........f Daze _
I
f City .........................
Stec ZIP
Installer/Contractor/Dealer Phone Contractor's registration number
Address ............ ...
........................... ..............
City . ...............•.....
State ZIP+4
Check the appropriate boxes in section A and section B.
A UB Alteration Inspection(check appropriate boxes below FEES
Commercial Coach ) $75 00
Air Conditioning/Heat Pump
: :. Electrical
Mobile Home Electrical Appliances
Fire Safety
$criai No:: Gas Furnace
Gas Piping
Run Ivo Plumbing
Structural
Recreational Vehicle or Park Trailer Wood/Pellet Stove - - eriel Ivo.
Serial No Plan Review - _ _ �' ----- $70.00
RV inspection - -- -- - - -- - $75,
Model No or Plan Approval No. ngtna etmlt
00
Re-Inspection- - - _ _ $50.00
Technical Inspection — ———— —— — — — — —— —— $50.00/hr
Signature of applicant or authorized representative Make check payable to: Dept.of Labor&Industries
X FEES DUE :. . -
D artmcnt usts only
Request APPROVED or. Request DENIED because of Specific Violations Of Washington Rules And Regulations.
Violations Must Be Corrected And Reinspection Requested Within 10 Days For Recreational Vehicles And 20 Days For Mobile :>
Homes and Commercial Coaches of the notice of violation date. (This does not apply to technical inspections). It Is Unlawful To
Offer For Sale,Rent,or Lease Any Non-complying Mobile Home,Commercial Coach or Recreational Vehicle.
........... . . . .
..... .. . ...... . . . . . ..... .
q InC �a�e ='
s re aired which must be completed and fees submitted before reinspection.
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��1.���1 ':� � ✓^• `�I[� -�. � ���,.�" �...- Total pages
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F622 012-000 alteration permit 12/'91 White-Olympia Green-Contractor Canary-]nspector�Pik-P-rcha.�., G2enrod Purchaser