HomeMy WebLinkAboutBLD1998-00583 Labor&Industries Ke.'"4... ALTERATION 'E ' IT
P,..t-cry Assembled Structures Section e•'t 1;;.t
Do not complete shaded areas
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(-Permit# ,*, 0 '\
INSTRUCTIONS:
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1. Complete all spaces,Including the signature box(marked with an X).
Invoice#
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.
—Insi
4. Contact and schedule the inspection with the same L&I office within 15 days. gnia#
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Owner last name first name Day time phone Date
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r:i Ry L)Av 10 c CAT44E-R 1 KJ E.-. c —1 a61 11 - 72 5 2.-
9 II i I
Address i City State ZIP _i —I,_,t /--. 1 p ' R
i t 75-
, .)C.2<4 411 ry \\NA
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Installer/Contractor/Dealer
Phone Contractor's registration number
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Address
City State ZIP+4
,Cheek the appropriate boxes in section A and section B. dee_er—f Lai i e... FEES
A r---6
Li Commercial Coach B IN Alteration Inspection(check appropriate boxes below) $
I Air Conditioning/Heat Pump
Serial No.
II Electrical
• Electrical Appliances
Mobile Home
II Fire Safety
Serial No II Gas Furnace
. Gas Piping
II Plumbing
I, Structural
Serial No I
II Recreational Vehicle or II Park Trailer II Wood/Pellet Stove — — i
serial No. Plan Review
RV Inspection
lOnginal _
MooleiN—o:—or7P1-an--A—pp-rovailTo---- -— Reinspection Permit 1
Ne. $
V Technical Inspection
CSignature of applic Or authorized re sentz,
,e,..._ —/-
' N Make check payable to, Dept.of Labor&Industries
.6
. (-I
..'", I UE $
• Department use only
1110 Request approved or a 14iittest denied because of specific violatio rag Of Viias:iington roles and regulations. Violations must
•
be corrected and reinspection requested within 10 days for recreational veld&-,:s and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to teehnicr' ",,.. r J.lionS). it is unlawful to offer for sale, rent, or lease any
non-complying mobile home,commercial coach or/recreational v,..hicle,
1111 Included are forms retur red which ITIUSt be oompleted and fees Kabilltitted before reinvection. '',
nay .._________ Area office inspector
Total pages ultt;
F622-012-000 alteration pe
11-47 White-Olympia Green-Contrator Canary-Inspector Pink-Purchaser GoIdenrod-Purchaser k.,,,,'4, •
.,44... .,
- .41 %
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