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Home My WebLink AboutAlteration Permit 8459 - OT General - 11/23/1993 T.- ."gip°"orxRfliv Department of Labor&Industries / ALTERATION PER T Factory Assembled Structures Section Do not complete shaded areas INSTRUCTIONS: Permit# V Q n 1 ' ` �7 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. CAr G 5 4. Contact and schedule the inspection with the office In which you submitted the permit Insignia# within 15 days. Owner last name first name Day time phone Date ..............:: ,..t -_:.:r '-- .......................t1.4�`5--............... ............. - '1--.. -T.. ....... z'��. ..... 1.... c�.......r�>. ...... Address City State ZIP Installer/Contractor/Dealer Phone Contractors registration number Address City State ZIP+4 Check the appropriate boxes in section A and section B. FEES A B ❑ Alteration Inspection(check appropriate boxes below) $75.00 Commercial Coach Air Conditioning/Heat Pump lectrical Serial No. E lectrical Appliances Mobile Home Fire Safety Serial No. Gas Furnace Gas Piping 09 -128/93 13:1]t3 93149430 HUD�No. Plumbing 75.00 S tructural Recreational Vehicle or ❑ Park Trailer Wood/Pellet Stove — — Serial No Serial No. Plan Review — — — — — — — — — — — —— — — —— —. $70.00 RV Inspection — — — — — —— — — — $75.00 Model No.or Plan Approval No. Re-II1Spectlon— —— — _ Nog ma Permit 1 $50.00 Technical Inspection _ __ __ __ _ _ __ _ _ _ _ $50.00/hr Signature o5 applicfnt gr authorized representative Make check payable to: Dept.of Labor&Industries X FEES DUE e artment use 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. Included are forms required which must be completed and fees submitted fore reinspection. Dat - Jotf� Total pages r— F622-012-000 alteration permit 12/91 White-Olympia Green-Contractor Canary-Inspector Pink-Purchaser Goldenrod-Purchaser -qrp- I 1 Draw map eivinjidirections to location on the Wfflu COPY ONLY. EAddress State Zip N W E S llept.of Labor&Industries Offices ABERDEEN EVERETT OKANOGAN TUKWILA 415 W Wishkah Evergreen Way Business Center 1234 2nd Ave S 12806 Gateway Dr PO Box 66 8625 Evergreen Way Ste 250 PO Box 632 Seattle WA 98168-3311 Aberdeen WA 98520.0013 Everett WA 98208-2620 Okanogan WA 98840-0632 (206)248-8240 (206)533-9300 (206)290-1346/1347 (509)826-7345 "Effective Feb. 15,1992 BELLEVUE KELSO OLYMPIA VANCOUVER 616 120th Ave NE Ste C201 711 Vine St 805 Plum St SE 10401 NE Fourth Plain Rd Bellevue WA 98005-3037 Kelso WA 98626-2621 PO Box 44430 Vancouver WA 98662-6302 (206)455-7048/1074 (206)577-2200 Olympia WA 98504-4430 (206)696-6295 (206)586-6085 BELLINGHAM KENNEWICK WALLA WALLA 2500 Elm St Ste F 500 N Morain Ste 1110A PORT ANGEte 1 1815 Portland Ave Ste 2 Bellingham WA 98225-2732 Kennewick WA 99336-2607 1026E 1st s Ste Walla Walla WA 99362-2246 (206)676-2083 (509)735-0100 Port Angeles 98362-4020 (509)527-4437 1-800-544-1509 (206)457-2572 KENT SPOKANE WENATCHEE BREMERTON 19435 W Valley Hwy E 3901 Main Ave 123 Ohme Gardens Rd Ste 203 4841 Auto Center Way Ste 201 Bldg S Ste 108 TAF C33 Wenatchee WA 98801-9634 Bremerton WA 98312-4379 Kent WA 98032-2114 Spokane WA 99220-4033 (509)663-9713 (206)478-4926 (206)277-7272 (509)456-2793 *Until Feb. 15,1992 YAKIMA EPHRATA 1716 S 16th Ave T 21 C Street SW MOUN VERNON TACOMA Yakima WA 98902-5789 Ephrata WA 98823-1895 1220 Memorial Hwy 1305 Tacoma Ave S Ste 305 (509)454-3760 (509)754-4608 Mt VernonWA 98273-3262 Tacoma WA 98402-1988 (509)754-4608 Mt V rnon 50 (206)596-3814 The following offices will be moving in the near future. Locations not known at this time. Kelso Mount Vernon � V� 1 v ww. •, "' wzy fiat' +;r 4'!' f 4' Department of Labor&Industries '' Facto Assembled Structures Section ALTERATION PERMIT Factory Do not complete shaded areas INSTRUCTIONS: 'ermit# 8459 1. Complete all spaces to and including the box with the signature X In It. Invoice# 2. Then draw map on reverse side of WHITE copy only. CX 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 permit Insignia# within 15 days. Owner last name first name Day phone hone I Date �r .� ................. Address City State ZIP Installer/Contractor/Dealer _ Phone Contractors registration number (il p- % '. 6j ............... .1/ 1( x�r...6:-�G�!........, :. .....4:..!..:.'...:....... city State ZIP+4 J Check the appropriate boxes in section A and section B. FEES A B ❑ Alteration Inspection(check appropriate boxes below) $75,00 Commercial Coach Air Conditioning/Heat Pump Serial No. Electrical electrical Appliances Mobile Home Fire Safety { Serial No, Gas Furnace Gas Piping ZIA, 4^W 101�y� S31� P: f5>r IIUD�No.N Plumbing Structural Serial No. Recreational Vehicle or ❑ Park Trailer Wood/Pellet Stove — — Plan Review — — — — — — — — — — — — — — — — — — $70.00 Serial No. RV Inspection — — — — — — — — — — — — — — — — $75.00 OriginalPermit Model Model No.or Plan Approval No: Re-Inspection— —— — — No. $50.00 Technical Inspection — — — —— — — — — — — — — — — $50.00/hr Signature olr applicant'' r authorized representative Make check payable to: Dept.of Labor&Industries X _;� FEES DUE $ -2. ". D artment use 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). Ills Unlawful To Offer For Sale,Rent,or Lease Any Non-complying Mobile Home,Commercial Coach or Recreational Vehicle. / Q . . . _ . - . -- . _ - /.CR.r!t . . . - .sf _ _! .S.c 1 j f/ U T C.�i v . .�Y r.Zl�Z< fO- 1 v.�i(�, :� dI k Ae . . . . .. . . . . . .. . . . . _ . . . . -. . . . a✓.0. Included are forms required which must be completed and fees submitted before reinspection. Date Area office nspector Total pages F622-012-000 alteration permit 12/91 White-Olympia Green-Contractor' Canary-Inspector Pink-Purchaser Goldenrod-Purchaser