HomeMy WebLinkAboutAlteration Permit # 147593 and 147594 - BLD Permit / Conditions - 11/13/2000 Department of Labor&Industries ALTERATION PERMIT
a
Do not complete shaded areas
Factory Assembled Structures Section
Permit a 147,593
INSTRUCTIONS:'
t Complete all spaces,Including the signature box(marked with an\). Invoice N
Draw a map on reverse side of WHITE copy only.
Forward completed permit and fees to the nearest L&I office. See list on reverse. Insignia N
4. Contact and schedule the Inspection with the same L&I office withln IS days.
7 rst name 1)a ttiime phone —7 /1 Dste
O last nay c f - � J` / — /�/ �V A ' J -�
�ln -
1/••/(;�•�- C _.._.F`C City State ZI/�
Odras C \ L J 9
Phone Fe f<K t ( 1U e'C t Contractors registration number
Installer/Contrw:tor/Dealer ( ) �)Z.-7 '��
._ .. City CRII 1JeiC�1-7-fair— ZIP+4
A .
Check the appropriate boxes in section A and section B.
A B ❑ Iteration Inspection(check appropriate boxes below) $
❑ Commercial Coach Air Conditioninoicat Pump
serial No. Electrical
Ir ( Electrical Appliances
Mobile Home ( Fire Safety
' Gas Furnace
Serial No.
( Gas Piping Activity ID : 2 001NNO
HUD No. ( Plumbing Application : f14759
( Structural
❑ Rc�national Vehicle or ❑ Park Trailer ( Wood/Pellet Stove — —n
/2040 08a41TIS
Serial No. Plan Review — — — —— — `' "'�
RV Inspection -�T- $
Model No.or Plan Approval No. Rcinspection — — — — — No.
Technical Inspection — — — — — — — — — — — — — — — $
Note: This permit expires one ear after date o )urchase. (Non-re undable)
Signatur o applicant or a ttwrized rcprpentative Make check payable to: Dept.of Labor&Industries
X l ,
FEES DUE $ S Z
Department use only
Request approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and relnspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
nlawful to offer for sale, rent, or lease any
of the notice of violation date. (This does not apply to technical Inspections). It Is u
non-complying mobile home,commercial coach or recreational vehicle.
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- ❑ Included are forms required which must be completed and fees submitted before reinsptxKion. * Total pages
Date Area office inspector
_ - Ghasa Goldenrod-Purchaser
F622-012.000 altcmdonpmit 8.yy White-Olympia Canary-Inspoctor Gf -Contrator Pink-Pun I
f
j n
Department ofLabor Industries Ra,9tAT A ALTERATION PERMIT
Factory Assembled Structures Section _ Do not complete shaded areas
INSTRUCTIONS: �'"1::��°� Permit# -•�
594 I. Complete all spaces,including the signature box(marked with an X). } r
Invoice#
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fees to the nearest L&1 office. See list on reverse.
4. Contact and schedule the inspection with the same L&1 office within 15 days. Insignia#
Owner last name first.name Day time phone _ Date
• I
Address y _.......
Cit State ZIP
Installer/Contractor/Dealer Phone Contractor's registration number
j •K � . __ %z->�. ' _tom..
Address City _r State ZIP+4
4-
Check the appropriate boxes in section A and section B. ES
AFE❑ Commercial Coach B Alteration Inspection(check appropriate boxes below) $
Serial No. Air Conditioning/Heat Pump
Electrical
Mobile Home
Fire Safety
I
<-Ejp"t� al_-ApEliances-
Serial No.
Gas Furnace
HUD No. Gas Piping - -
Plumbing
Structural
Recreational Vehicle or Park Trailer Serial No.
Wood/Pellet Stove — —
Serial No. Plan Review
Model No.or Plan Approval No. RV Inspection — — — — — — — — — — — — — - - - $
ngmal Permit
Reinspection — — — — — No. $
Technical Inspection — — — — — — — — — — — — — — — $
Note: This permit expires one year after date of purchase. (Non-refundable)
Signature of applicant or authorized representative Make check payable to: Dept.of Labor&Industries
X FEES DUE $
Department use only
R ues to r v o ed or Req
uest denied because c f eq PP e o specific violations f❑ ❑ 9 p o 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.
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- - - - • • - - - - - • • . . . . . . . . . . . .. . . . . . . . . . . •- • -- • • - - - - . .. . . . . - - - - - •- • - - . . .. . . .. . . . . . . . . . . . . . . . . . . . . .
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- - - - - - " - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • - - . . . . . . .. . . . . .
❑ Included are forms required which must be completed and fees submitted before reinspection.
Date Area office Inspector Total pages
F622-012-000 alteration permit 8-99 White-Olympia Canary-Inspector Green-Contractor Pink-Purchaser Goldenrod-Purchaser
i