HomeMy WebLinkAbout1331 W 10th St - Building
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000256 Date
846912
1331 W 10TH ST
06-30-00-0-3-0465-0000-
RES NEW SFR
4/25/05
RS7 RESDNTL SINGLE FAMILY
100771
Owner
Contractor
Structure Information
Construction Type
Occupancy Type
Other struct info
000
ACE MICHAELS INC.
431 VASHON AVE.
PORT ANGELES
(360) 417-9579
000 1502SF SFR W/ATT 553SF GARAGE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98362
CAUDILL MICHAEL R
431 VASHON ST
PORT ANGELES
WA 98362
29.70
V-N
1. 00
1. 00
7000.00
2082.00
2082.00
1. 00
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
1502SF SFR W/ATT 553SF GARAGE
47522
1022.85 Plan Check Fee
4/25/05 Valuation
10/22/05
409.14
100771
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1. 00
BASE FEE
5.6000 THOU BL-100,001-500K (5.60 PER K)
Extension
1017.25
5.60
Qty
Unit Charge Per
Permit MECHANICAL PERMIT
Additional desc
Permit pin number 47613
Permit Fee 101.35 Plan Check Fee .00
Issue Date 4/25/05 Valuation 0
Expiration Date 10/22/05
Qty Unit Charge Per Extension
BASE FEE 47.00
1. 00 14.7000 ECH ME- INSTALL 100- FAU 14.70
4.00 7.2500 ECH ME-VENT FAN 29.00
1. 00 10.6500 ECH ME-GAS PIPE 1 TO 5 10.65
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permi t . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
47605
132.00
4/25/05
10/22/05
Plan Check Fee
valuation
.00
o
Qty
Unit Charge Per
Extension
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
nutl and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
fot a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 <;lays from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laWS and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
tf-J. S-~~
Date
Signature of Owner (if owner is builder)
Date
Sig
T:\PoliciesIII02_15 building permit inspection record05.wpd [114/2005]
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BUILDING PERMIT INSPECTION RECORD
"
!
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND A CCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE / DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I I
MECHANICAL
HEAT PUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\Pohcles\J 102_15 bUlldmg penmt mspectlOn record05.wpd [1/4/2005]
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CITY OF PORT ANGELES
'DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32 I EAST 5TH STREET, PORT ANGELES, W A 98362
Page 2
Application Number 05-00000256 Date 4/25/05
Application pin number 846912
Qty Unit Charge Per Extension
BASE FEE 47.00
8.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP 56.00
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE 7.00
1. 00 15.0000 ECH PL- EA. BLDG SEWER 15.00
1. 00 7.0000 ECH PL- EA.WATER HEATER 7.00
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
The proposal will result in a s.f. res with attached garage
for total lot coverage of 30% in the RS-7. No land use
issues are noted.
Electrical load calculations and elctrical permits are
required.
Customer servce underground to avoid a tresspass.
Connection fee $410.00.
Sidewalk to City standards required for school walking
route along 10th. Street
Sanitary sewer connection inspection is required by
Public Works prior to bac~ fill of ditch.
Construct driveway to City Standards.
No concrete with exposed aggregate allowed in the City
road right of way.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1256.20 1256.20 .00 .00
Plan Check Total 409.14 409.14 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 3439.84 3439.84 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
fora period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\1102_15 building pennit inspection Tecord05.wpd [J/4/2005]
BUILDING PERMIT INSPECTION RECORD <()..s - i2 5'
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIQNS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS UA.-I~ r'" \ L1-
'" , "
WALLS H ;l e'::' ""Ji.L
S" -0 -0..:.>
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING fiW $ ~ COn II -ew-f,MS R,V 7~f*-~
UNDER FLOOR 1 SLAB
ROUGH-IN I I .
WATER LINE (METER TO BLDG) q-a. 7-(!)5 .Il--l-
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS 11I'~2J.I-o~
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS In-:JJJ-or:::.
WALLS 1 ROOF 1 CEILING J()-2J.i-os J t-t.
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE J J-IS-O~ .\j.-L-
WOOD STOVE 1 PELLET 1 CHIMNEY
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 . i ~ PLANNING DEPT.
BUILDING 417-4815 l:J, IIt/lt:?/- ,:TL--lr BUILDING
T:\Policies\1102_15 building pennit inspection record05.wpd [1/4/2005]
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BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BI' ,
COMPLETE to be accepted for review. If you have any questions, call,!
PERMITS (360) 417-4815 FAX(360)417-4711 V
Dale Approved:
Date Issued:
Applicant or Agent: tM...~ L b' C d J J ',\ ,
Owner: M \ ( ~~ I L~dj~ \ ,
Address: 4 '3 \ VclC":)\r","-,-i\. S~ City: ~ A..
Architect/Engineer: J..-.~ ~ ~O I S~\ ~
Contractor ALe ~,~ \A....~\"";) 4< , State License #:
Address: '1-1, V ~S iu. i\. ~ ~ City:
PROJECT ADDRESS: 133 l iA.J ~D I-- \.1.
I ''3
Phone:
Phone:
~'1-9S7?
'717 -9 5/~
L? 83 <.:,j,
Zip:
Phone:
Exp:
Phone:
~~
Subdivision:
Zip:
ZONING:
IrA
f~3~~
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
30y
Ob'~ 0000 :5bl.{ b5
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA MC #
TYPE OF WORK:
~Residential ~ew Constr. D Re-roof
D Multi-family D Addition D Move
D Commercial D Remodel D Demolition
D Repair D Sign
BRIEF DESCRIPTION OF THE PROJECT:
City:
;zf Stove
D Garage
D Deck
D Other
S
SIZEN ALUATION:
I S-C j SF. @ $
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories:" Lot Size: ~ Existing Sq. Ft. 125
Total lot coverage d (1 ./ %
Occupant Load: Construction Type:
& Proposed Sq. FtJQ 9~ = TOTAL Sq. FtJO O'J
ESA/Wetland(s): DYes D No SEPA Checklist required? DYes D No Other:
APPRO V ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building pem-lit application and construction plans are
submitted. All other pernnt fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno pernnt is issued witlnn 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section Rl05.3.2
ofthe International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that J have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are require ,not the City's, and that J must obtain such permits prior to work.
Date: 1- Co-oS-
T:\RVESS\B LDG- forms-brochures\2004- Buildingpermit. wpd Applicant:
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AGENDA
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UVIL..L.1I1.._ 1'"'\ . 1-1""'1'"'\11'-'1" I'-'-VII-I!I! ""'.....I.III!II-I..I V
DATE: APRIL 11, 2005
LOCATION: SEND COMMENTS TO PERMIT COUNTER
ITEMS TO BE REVIEWED:
D~
Y
1. REVIEW PLANS FOR A NEW 1502 SQ. FT. SFR WITH A 553 SQ. FT. ATTACHED
GARAGE & 27 SQ. FT. OF COVERED PORCHES TO BE LOCATED AT 1331 WEST
10TH STREET FOR MICHAEL CAUDILL.
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PLEASE SUBMIT COMMENTS TO PERMIT COUNTER, THANK YOU
TRENIA F. GAILM. .JOHN H. J.lM M.KEN D. RONB. SUER. BILL H.
Lfi~": DS
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For the Washington State Energy Code (2003 Edition)
Climate Zone 1
PerrrHt#:
Lot:
Site Information
?f~ &'aG~ '30,/
Address:
Notes:
City:
State:
Contact: > ' ~
Phone: '-I ( I
Phone 2: 4 Co 0
Fax: 'I 5 7
Zip:
Ca~d'. \ \
95:/7
~'( d
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Table 6-1
PRESCRIPTIVE REQIDREMENTS 0,1 FOR GROUP R OCCUPANCY
CLIMATE ZONE 1
(Unlimited Glazmg 0 tion Only;
Glazing Glazing U-Factor Door9 Wall Wall Wall Slab4
Option Area 10 U- Ceiling2 Vaulted Above lnt4 Ext4 Floors On
% of Floor Vertical Overhead 11 factor Ceiling3 Grade Below Below Grade
Grade Grade
III Unlimited
Group R-3 0.40 0.58 0.20 R-38 R-30 R-21 R-21 R-I0 R-30 R-lO
Occupancy
Only
I )
See the code text for footnote references
This project complies with the following:
./' The project is a single family residence or duplex.
./' The project is wood frame OR all of the insulation is interior or exterior of the framing.
./' All building components meet the requirements listed in Table 6-1, Option III.
./' The project will meet all other provisions of the WSEC and VIAQ.
The project will take advantage of the following exceptions to the prescriptive option:
D 602.6 Exception 1. One door, that is 24 ft.2 or less, that does not meet the standards is allowed.
Location of the door taking this exception
D 602.6 Exception 2. Doors with a U-factor of 0.40 allowed without calculations, Option III only.
Location of the door(s) taking this exception
Copyright 2002, WSUCEEP02-056
Copied by permission from the Washington State University Extension Energy Program
Prescriptive - Simple Form - Climate Zone 1
7/26/2004
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
'l21 EAST 5TH STREET, PORT ANGELES. WA 98362
~~
'- -
....
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Appl~cation type description
Subdivision Name
Property Use
Property Zoning
Appl~cat~on valuation
05-00000256 Date 10/20/05
846912
1331 W 10TH ST
06-30-00-0-3-0465-0000-
RES NEW SFR
RS7 RESDNTL SINGLE FAMILY
100771
Owner
Contractor
CAUDILL MICHAEL R
431 VASHON ST
PORT ANGELES
Structure Informat~on
Construction Type
Occupancy Type
Other struct info
000
ACE MICHAELS INC.
431 VASHON AVE
PORT ANGELES
(360) 417-9579
000 1502SF SFR W/ATT 553SF GARAGE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98362
WA 98362
29 70
V-N
1 00
1 00
7000 00
2082 00
2082 00
1. 00
'""
UJ
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..........
Permit
Additional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Exp~rat~on Date
ELECTRICAL NEW RESIDENTIAL
JEDI/ 2055 SF SFR
62547
JEDI ELECTRIC
119 80
10/20/05
4/18/06
t'
(:..,
Plan Check Fee
Valuation
00
o
Qty
1 00
2 00
Unit Charge Per
73 0000 ECH
23 4000 5C
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 500
Extension
73 00
46 80
"-
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\}.
Special Notes and Comments
Bu~ld~ng address s~gn shall not be less than 6" & not more
than 12" in height Numbers colors must contrast with wall
color they are mounted on (Ord 14 36 050-E)
When roof gutters are installed, dra~ns will located in dry
wells or piped to approved storm drain locations.
The proposal will result in a s.f res with attached garage
for total lot coverage of 30% in the RS-7 No land use
issues are noted
Electrical load calculat~ons and elctrical permits are
requ~red
Customer servce underground to avoid a tresspass.
Connect~on fee $410 00
Sidewalk to City standards required for school walking
route along lOth Street
San~tary sewer 'connection inspection is required by
Public Works pr~or to back fill of ditch.
Construct driveway to City Standards
No concrete w~th exposed aggregate allowed in the City
lI\
:;
COMMENTS! ACTION NEEDED
~
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~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
121 EAST 5TH STREET. PORT ANGELES. WA 98362
Application Number
Application pin number
05-00000256
846912
Page 2
Date 10/20/05
Special Notes and Comments
road right of way
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745 00
4 50
1025 00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 119.80 119.80 00 00
Plan Check Total .00 00 .00 00
Other Fee Total 1774 50 1774 50 00 00
Grand Total 1894 30 1894 30 00 00
COMMENTSI ACTION NEEDED
"
ELECTRICAL PERMIT INSPECTION RECORD
;
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
NO
GENERAL COMMENTS:
PW-II02 U (4'961
Installation description
Job wired by ~'Electrical Contractor DOwner D Commercial )'l Residential
Electrical contractor name License number Date Expires
;)EOI G~ -, ~,\)/ BE ""'''IS >c- Z DNew o Altered/Addition
-~r,c..
Purchaser's mailing address /700 S:y, FI
P,o. t50JC 6S,r
City A State ZIP
p. ~Jc- O,J'3G;)'"
Telep~7e number FAX number
l.. 60-0SS6 L(( 7- ft:jc) 7
Premises owner's name
m,' i~ Lc.lAd, '0
Address of inspection 10 7~ 5'(
~::5~( we,"'- /5"0:;..
City P f,IA1e/~S 5""53
",T
Phone number to schedule inspection: 2..0 55"
Owner as defined by RCW.19.28.261:(J) Owner will occupy the structure for two
years after this elec/rical permit is finalized. (2) Owner i~' required to hire an electrical
contractor if ahove sajd property is for sale, rent or lease. D Cash D Check #
After reading the above statement, I hereby certify that r am the owner of the above @)
named properly or a licensed electrical contractor. I am making the electrical instal- ~redit Card Mastercard Discover
lation or alteration in' compliance with the electrical laws, N.E.C., RCW. Chapter
19.28, WAC. Chapter 296-468, The City of Port Angeles Municipal Code, and Card # - - -
Utility Specifications. ----------------
~~gnatm~2 ;nt..ctor or eI;~;;;~ i~;~;;~~ Expiration Date ($nspe;t;, f~BO
of card
Electrical !'oad Additions and or subtractions .
Service Information .
If.ORt_..
>I:,~"~<"
o~.
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L=.
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ELECTRICAL WORK PERMIT APPLICATION"'-'~
;1--"'-
f'~
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o NO LOAD CHANGES
D Baseboard KW
D Furnace KW
l:I Heat Pump Ton
o Fan.WaIl KW
LAR
D Overhead Service
D Temp Service
D Underground Service
Voltage
Phase 0 1 0 3
Service Size:
Feeder Size:
.'
I '
SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735
ROUGH-IN I' THERMOSTAT SERVICE
/,/""./;',, .47.-0 /".1'7, /~ / kO I$/;;Lo In < kD
/Datol Approved By \.- /Dale/ Approved By Date/ Approved By
,... ,,- FEEDER
FINAL DITCH
/~h<;/I'>';- ~&, JO/u4,~ ,IdJ
./ D3Je '-.... / Dale/ Approved By / '-.... Date Approved By/
Inspection Area, Building or Equipment Inspected Action Taken Electrical
Date Inspec~or
/oJ 1'7 /1)17 llniJ IJ G!.--r toO p0 '" dJ. A-I () <ill. Ac...<-/
",.-~
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ELECTRICAL INSPECTION ";,
WIRING REPORT
417-4735
~
tJ5 - .:z
PERMIT #
.::JTv:c
ADDRESS
:3 3/ c.-J
/tJ~
~r
APPROVED NOT APPROVED
o .................... DITCH. . . . . . . . . . . . . . . . . . . . 0
D. . . . . . . . . . . . . . . . ROUGH IN/COVER. . . . . . . . . . . . . . . 0
D. . . . . . . . . . . . . . . . . . . . SERVICE. . . . . . . . . . . . . . . . . . . 0
yr. . . . . . . . . . . . . . . . . . . . FINAL .1?~/.:Jd",J/p' . . . . . . 0
CORRECTIONS NEEDED V ~ ~ 'A.h -e.t- /A/
/5 LA7t::L,O
cV /-fr=k - <'~
~s r;;.-r~"",r
/;:>/72>~ /.3~
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381