HomeMy WebLinkAbout934 Benjamin Ave - Building
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CITY OF PORT ANGELES
DEPARTMENT OFCOMMUNITY DEVELOPMENT -BUILDING DMSION
321 EAST STH STREET, PORT ANGELBS..WA 98362
~~~~C4~~on ~umoe~
Property Address , .
ASSESSOR PARCEL NUMBER:
Tenant ~r ,name
AppHcation.description
Subdivision Name
Property Zoning . . .
Application valuation
03-00000742 Date 8/11/03
,934 BENJAMIN ST
06-30-15-6-4-0010-0000-
TEAR OFF/FELT/COMP
Rf:-ROOF
1600
owner
Contractor
TO TANYA. B
934 BENJAMIN ST
PORT ANGELES
WA.98362
AFFORDABLE SERVICES
258663 HI -WAY 101
SEQUIM
SEQUIM
(360) 452-5264
WA 98382
-------------------------------------------------~-------------------------- .
Permit' . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PRFEE
80.55
8/11/03
2/08/0~
Plan Check Fee
Valuation
.00
1600
Qty
Unit Charge Per,
11. 00
3.0500 HND
BASE FEE
BL-501-2K
(3.05 PER C)
Extension
47.00'
33.55
-------------~---~---------------------------~------------------------------
" '
Other Fees
STATE SURCHARGE
4'.50
-.Q
\).J
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ----------, ----------
~ermit Fee Total 80.55 80.55 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee T01;:al 4.50 4.50 .00 .00
Grand Total 85.05. 85.05 .00 ' .00
r
p
~
~
00
'~
Separate Permits are required for electrical work, SEPA, Shoreline. ESA, utilities, privatEfand public improvements. This' permit becomes
null and void ifwork or construction authorized is not commenced within 1,80 da~, if construction or work Is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection..1 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 perforrrlance of
construCtion. '
C9YJP1/~
~ignature of Contractor. or Authorized Agent
,
Date
Date
Signature of Owner (if owner is builder)
,
T:\PLANNING\FORMS\1102.1S [412002]
..
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION. .
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECfION TYPE DATE ACCEPTED - COMMENTS
YES NO "
FOUNDATION: ..
FOOTINGS
WALLS
FOUNDATION DRAINAGE ,
ELECfRICAL (LIGHT DEPT) SEPARATE PERMIT:"
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB I
ROUGH-IN .
WATER LINE .
GAS LINE. .
. BACK FLOW / WATER , ' .
AIR SEAL
WALLS I I
CElLING I I . I
'. , .
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYW AU. ,
T-BAR
INSULATION
SLAB . I
WALL / FLOOR f CEILING I
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET f CHIMNEY
HOOD f DUCTS ,
PW UTILITIES f SITE WORK (Engineering Division) SEPARATE PERMIT /#'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT /#'s SEPA:
PARKINGfLIGHTING 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./ PWf CONsTRUCTION - R. W. . ..
ENGINEERING 417-4807 PW / ENGINEERING "
FIRE 417-4653 FIRE DEPT. .,.'
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 q -15""-C '7. ..J ,J.., BUILDING
JWL-31,-2003 10:39 AM 2D673A53.73784237
""".--i'" ~_
,360 582 9029
P.01
( ,
13e"041'74T'I'" ",. ",'t'>e;'l;',-,"'/ 1
, ','\ ;.'. ."i~.,: :t"M.~(J'~tff".;)' ,
7-31-03; II04AMICITY ~OAT AN~.~5&
s
BUILDING PERMIT. APP'lICATION
FOR OFFICIAL USi ONLY~
DitabG.t
Pml": 'l- II ~
Date Apprand:
0.. r.-\:
Fro Ololt COMPlZrItL Y and In INK. Your appUcatlOD aDdllte p.u.MUST BE
COMPLETE to be accepted for review. II you bave allY q1LllldoDl, caD
(J61t) 417-4815
Appli~ant or A'F1t:~t:t:ffrc0w 512 r jJ la (';, Phone: VI (J tbe~ q U Iq
own~r:~rALt , ,',,'Phone: 2()c, 7q(j 'EJ'O.t)
~!LS: ' city:_fi:Lrhr.tv'<(~ (JJiA..- ZiyJ:Ift>ZO-34zl-
Arcbit=ct/Engineer: ' . Phone:
. I ,.. C' A !::F- 0 /2.. -.>;f( OW5~~ '. /' 11'2.11 ,
Contral.-tor ~ ~ t; .1C2;t"\..~U II vtA State License fr. " , :-EX'Pi · rr...'fj5 oPhonrs:,"",:-M (p a
Address: l~(i- ~HW'-l /r)\ City: .Y2go f f'v\ '.. IA/~ Zip: c{P1~(-7(j~
PROJECt ADDRlSS:.E.$ f':i ~a fY\ 1 V'\"ZO~GI
LEGAL DBSClUP11ON: Lot: B10C1k: Subdivision:
,CLALLAM C01JNTY PARCEL NUMBER:
C.- cu.l1Io1dor N..... ~i ~' f62.:!:l: ~ ~
~=~~C~~
TYPEOrwoJUC: 'SIZlNALV4T1ONI': .
C llNicIati&t Q NIWCODI1r. ~f I:l Stove '. Sl'.@S 181'.-1
o Multi4amiJy C AddiUon C Move C Garase SF. @S ISP. -.
[J CoaI:nIIWl C a.aodel C Denlclition c' Deck ' Sf\@ s JSP .,-' .
, c lr:ptit C Sjp C Other TOTAL VALUATION $' {111J0""
BB'lEPDESCllIP'l10N OP THE PROJECT: r~p-y 6 v::i:: / P t f-/ (CJ/Y'la . '
I (I.
, OCGUplDt t..O~:' f'.
&0 Propoaoci Sq. Ft.
% · T01al1ot CDVUBse
ConatnlC11on -r,pe:
-TOTALSqA--_
%
COMMUCWJUSIDJ:NnAL: OcQ\Ipenoy OtDup;
No. of Storlea: _ Lot Size: lWsting Sq. l'l
Bxi.stiq lot ' erap % & Pr cl10t coVCt'asc
COY - opoatl -
... >,~,,;;,.,';;' , AtPROVALS:
,
PLANNING USB ONLY: .. PLAN.
, BLDG;
DPWuI_
ESAlWolJand(a): C Yea C No SErA Cbcc:ldlatRquircd1 eYes C No c>1lwr: ~:
Om&al_
BUILDING PERMIT APPLICA110N SUBMITTAL; Thc 8uildiq Diviaion ~ID p:o'Vidc )'Oil witillDfonaation on dJo app&atiOll and
plllllUbmmal rcqu!IlIIDI:GJI it yo\' bave quatioDt.
V ALVA-TlOli Oll' COlSSTaucnON: ID aU CUll, . valualion IDlllwat mull be IIlrend by the awUc:uat. Thill fipn will be reviewed
and Ulaybe m'lIad by1be B1IJJdJD; DivilioD to ~ly with C\lD'ent fee schedules. CoDtact6e Pennit CooEdiDaIDnt417 -4815 t'ouuiltuce.
PLAN CHICK I'D: D. plaD c:bcck fee iI due itl1ll1lt be submiuad at the dD tho buildiaa pormit applieatiuD aud ooaab:uctiaD plllaue
eubmittld. All other pllmit'" are r!\I8 at the time ofpClrmit iuumce.
EXPDl4TlON OJ' PLAt'( BEVlEWa Uno pcmnlUIl.uued within 180 dayuttheclate of'applioatloa. tbD appUcde~ will apIre. The
BuiIdiq 0fDci&l QU Olden" tU timI for don by the 1pp]ig1l11 lip to 180 clay. upcm,mtteD ~c by tho app1lclDt (1M SICtioD. 107.4 of
tbe Ull1tbnn Bu11d1Dg Code, ~ edition). No appUcati01l can be atmdcd more than ODe'.
, htlBby c<<tty ttJat I have ItId 11I0 .mrmd th/8 application IfId know th8 SfJmt to be trut'ltid Cond.1 n Ilihorlzed fa sppIy for tJill pG1m/f end
llldoratfttd thtIf kif my f'NI1OM/bl/lty 10 d&trmnlnl!l whit pennltl8l81'tf1lJiBd ,not /h. C4)1I, IIId fII/it t rmrat ob"~ aur;h ,.",. prior 10 worlt
":\I'OI\M3WP8\8uII4It1IJ'tf17l1Lwpd AWlic8~14.#/ \,., .; i>atB: 'If.... 3?' -a.3
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PREPARED 9/15/03, 12:13:02
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
1
9/15/03
ADDRESS
TENANT, NBR:
CONTRACTOR
OWNER
PARCEL . . :
APPL NUMBER:
934 BENJAMIN ST
TEAR OFF/FELT/COMP
AFFORDABLE SERVICES
MEAD, TANYA/ROY
06-30-15-6-4-0010-0000-
03-00000742 RE-ROOF
SUBDIV:
PHONE
PHONE
(360) 452-5264
(206) 749-5890
PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
~~~~-~~----~/~~/~3~----- L -------:i:~:~-~:;~~:::::-::-;:::::::-~:~:;-;:-;:~:-:::::::::------
Jane at Affordable Services. Phone# 683-9619
---------------------~- -"------------ COMMENTS AND NOTES --------------------------------------
~
erTY OF PORT ANGELES
iLIGHT DEPARTMENT
ELECTRICAL PERMIT
N~
18088
Port Angeles, washlngtonnm..nmm!<.~/..m.m:::~L....m...m...m.m, 19j{1j
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
ttlcal equipment In, on, or about any building or other structure in the City of Port Angeles, per-
mission Is hereby granted to do electrical work as listed below.
Address nnnm9..3.~m.nnG'g.n:\.(..~:!."0..n.m.__h..n__....mnmn occupancy...nmlnc?J.d..i!J.(..1,n.n__...hh.
Owner f\ I-f :6. Qbh9lf...k.':'!mmn(..b.\...!.PQ TenanLnmmm.=-._.mn.mnmh:>mnnn.m.mm.nnm..n
Wiring ~.~~~a~~o~.:::.:8n~mR....E.h.!;jnr.!~~n__n.n.mm By.nn...(f-{dttA...LJ;;.AM.d....m.n.nh__..__.
LIght Outlets......................~.':i..._.._.___ ServIce, volts ......_..m_m..._......nm....... Type of Wiring:
neceptacle ouUetS.....m..../::/..._n........ No. wires m..................m............... Armored Cable ..............................
Non-MetalUc .....m....__Xm...........
pryer, KW..unn.n................n.............
Size wlres...m..mm.............n...m_..
H:ange, KW h..hn...........n.....
Water Heater:
Main fuse ............mm.....m....m......
Enclosure .......................................
KW._____................________________
Ifeat KW......_________.............___..______......______
Type of wiring:
Entrance Cable ..._.m...........m.......
~otors: size, volts and phase:
Rigid Conduit m.m....m.......
Meta1l1c Tubing ..................
Current transformers:
No. & Size.............._........................
Ser. No..............................................
Ser. No. ....._.......................................
Ser. No...............................................
Knob & Tube......_............n..........._
Rigid Conduit ..__.___.......................
Metallic Tubing m........................
Raceway ..............................._......_
Circuits, Light.......................................
Utillty..__.........................................
Heat ......................................._..__
Range ...._..........__......n....__..............
Water Heater ...............................
Motor ..._........................................
Dryer ................................................_
Furnace .........................._......_.._.......
Total Load............................. Ser. No......_..........._.......................... Total.......................................
lltemarks: ...l..d4..m.::..mn~..____~_"..:::::nmmlt...~~..:mmmmnmmmnnmmn...n.m.m..
.~u..U._..nn.n__.__n__uuun___._...n_n....n____nnn.u__h.____.._.n____..nn__nn__._..uh..._.n_n____unn._nn.~_.nnnnnnnnnuuu__~~u._u.~
.+.__nnnn_._nnnnn.uU__n.~~nnnnn__nnnunnuuh_____n._.n___n-n_____n__n.___n_._nn__nn_hunu_.nhnn.nnn.u.~u~n__nnnnnnn.nnn
Permit F<<:~
. /~~
,....___...........___mmn___.m..
Treas. Receipt
NO...Q.7....l..j..........
BY~~m:&:.._(l~
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. It work is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
(', /J GJf JJ~ d p~- N~ 18088
W ~ ELECTRICAL PERMIT
.. Address .....m.Aq..::...;i:;.~---G.I2.~tt.Y.l~L~--------..............n.---...............--n Date.......... _~~_.5./.3.../.~..':/.._...__....
Owner __........____....l.t.........b_....._.._............~_.......l...0..~L__......___._______ __... __..... Tenant.....__ _.
Wiring Contractor__.......ELci..Ji.__...E..l..t>..L.LC\r........--...................__________ By--:::::~:i)IL~;;;{:::::::!.~..~:~::
NOTICE-Current must n()t be turned on until Certlftcate of Inspection has been issued. If work is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
1M Olympic Printers, Inc.
16721
. If) -/ .3 >r
Port Angeles, Washlngtoll......._...u...m_._.mmm..m.mmm.mm...., 19.000000.
In accordance with the City Ordinance to regulate the Installation, extension, or repair of elec-
trical equipment In, on, or about any building or other structure In the City of Port Angeles, per-
mission is hereby granted to do electrical work as listed below.
Address m..f--.~uy..~~~~m.--uum...m. Occupancy.~.um..u_mmm.u.
Owner ,~.'-CC -.: J2...-t.-'\l..--:-mm~.?-"u,..~n:. m.lr...."4 ;J;enant..._nm..mmm_.um.__._.m.n.__.mu_.......m_...___.n
:;;-....~m--m--h-m._.~...,_-7--.. . ' . .J'.f'(~.
Wiring Contractor ....__'tll.Jf!c.rr.:!:::!::.:iLu 000.. .~~__u:.mumu~u Byu.ummmmmmmmnunm..__......._.mmm..__..m
LIght Out1et......L..~.......___.:___.._..... (fS~rvlce. volts .___/,,?O!...:?..P.:/f.. Type of Wlrlng:
'''' '3 /.. .
R I Ie Outlets ~ (;> "0 wire. Armored Cable ...._un.........__........_
ecep ac .........nnn_....n___...... l'; . .__..........__......__...___...____...
Dryer, KW 0000....;':2..00.....---...--..-- SIze wlre.......,/:-;;J~./1.........
Range. KW....___.......,.......__. Main fuse .__~.........._................
v'
Enclosure __...~_................n._.........
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
Water Healey I f
KW............---------A'l!;i-----...--
Heat !(W....//!....f~p----,.--.....
Type of wiring:
Entrance Cable ............__.........
Motors: size, .volts and phase:
/.. tJ~./~y;'
.l..C?~______......._____...............
RigId Conduit .____...__....__..___....
I,':
Metallic Tubing, .....0...........
Current transtormers:
No. & Size..m........nmm......n
,
Ser. No......................_.......................
Ser. No...................._.........................
Ser. No..............................................
N?
Non-Metallic _................__..........___.
Knob & Tube................................_
RIgid Conduit .......__...................__.
Metallic Tubing __.........................
Raceway .......1::....................-.--..-
CIrcuIt.. Llgh~__.....h..................____h
~ :~: ty ..~~~=~~::~~~~~~::~~~~~~::~:~~:~::~~
~
Range .............................................
;z,
Water Heater ...............................
:r:::~. ..~~~~~~~~..~~..-~~~~~~~..~~~~~:::~~~~:~~~==
Furnace ................................._.._.......
C?~
Total l.A)ad............................. Ser. No.................._........................__ Total ..._...................................
Remarks: ____...__m__...:.::?:'!",~:..____.__~.1----:i?:__ummm__m__mm.__m__mmm.mmmmmmmm__
.__.___~._....~....._.______._________________.__...___n_..__._._..._________________________.__._____.._._..._.__.._______.__________.____._______...__...__.____.___....____
.;:;:.ij:~m.--h--hmmmm.;~:~:.--~:~:~~~--m.mm.m.--------u----.m;[l!......il/~;J:::l:..'--
$__.-:-=..:.:mmh______m... NO..mm________.______._____ By ur-- m__ .m.mm'm_________m_m.mm.m___._tJ.~
"..
~OTICE-Current must not be turned on until Certificate of Inspection has been issued. If work is to be eon-
cealCld due noUce must be given the Inspector so that work may be inspected before concealment.
'<'.--.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
--- --_.-
ELECTRICAL PERMIT
N?
16721
Address...................................__........................................................................................._.........Date..._......_.._.._.._.:'........_...\.._......_......._
._'.........-..'""1
Owrter..................................._......_.._......_......_.._...........................................................Tenant....................................................................
\ WIring Contractor.........._________.....__........._.....................................................h.hh____....__............... By.__..__.............................____.___.........._......
NOTICE-Current must not be turned on until Certltlcate of Inspection has been issued. If work Is to be con-
cealed due notiee must be given the Inspector so that work may be inspected betore concealment.
1"'11.........1,... p,.;nt....... Ine_
A
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
Application Number . . . . 16-00000371 Date 3/17/16
Application pin number . . , 731785
Property Address . . . . . . 934 BENJAMIN AVE
ASSESSOR PARCEL NUMBER: 06-30-15-6-4-0010-0000- REPORT STATE SALES TAX
Application type description ELECTRICAL ONLY on your excise tax form
Subdivision Name . . . . . . to the City of Port Angeles
Property Use . . . . . . . .
Property Zoning . . . . . . . RS9 RESDNTL SINGLE FAMILY (Location Code 0502)
Application valuation . . . 0
Application desc
ductless hp
---------- ........
Owner
Contractor
VANESSA JONES
EXTRA MILE TECH L ELECT., LLC
934 BENJAMIN ST
418 N. RACE ST.
PORT ANGELES
WA 98362
PORT ANGELES WA 9B362
20) 749-5890
(360) 457-5222
Permit . . . . . .
ELECTRICAL ALTER RESIDENTIAL
Additional desc , .
Permit Fee
63.00
Plan Check Fee a 00
Issue Date
3/17/16
Valuation 0
Expiration Date
9/13/16
Qty Unit Charge
Per
Extension
1.00 63.0000
ECH EL-R-
BRANCH CIR WO/ SER FEED 63.00
Fee summary Charged
............
Paid Credited Due
Permit Fee Total 63.00
Plan Check Total .00
Grand Total 63.00
63.00 00 '00
.00 00 00
63.00 00 '00
Signature of owner or Electrical Contractor X_ITmmm .......... Date:
f
Building rvfst.orntEleetr.i;cm 1 s ectaoms
321 east Fifth Street.... P.O. Box 1.150 /Port Angeles Washington, 98362
Phi (360) 4174735 Fax: ( tD) 41.7 -471. t. ,,
Dater ..... ' . Y, & 2 Single Family Dwelling
JobAddress: M Bey Rer tnr , l Sea tl N f
x 6 Ism
Building Square Foots
Dirt eta eetr an Rob Information Sheet
Description of above
... .,
Owner Info nation Corarar for hifr„rrynadorr
Name k a'
Mailing Address i p�
i 4 � a ,.. a m. � Maiiji Address , a r '
p Clty.
city State a''tt�rte brie ..��
m r.� �..
I dtonr . S Fax: w.. .n I'hortn - p sa
license /Exp— __ - -.. «
[ten nit ar a Tot t� ( tr fw °;ItG lllw9 r�r) rtu4 � lfflg)
ServicelFeeder200 Amp. $120.00 $m„ �...,...
ServicelFeeder201A00Amp. $146.00 _...._ ..... f
ServicelFeeder401 -600 Amp $ 205.00
Service/Feeder 601 -1000 Amp. $ 262.00
ServicelFeeder over 1000 Amp. $ 373.00......, _..,
Branch Circuit Wl Service Feeder $ 5.00
Branch Circuit W10 Service Feeder $ 63.00
Each Additional Branch Circuit $ 5.00 _ .. ,, . ,mm..�... 1. ... ..._ .,...m.
Branch Circuits 1-4 $ 75.00 _.m........r $.....
Temp. Service/ Feeder 200 Amp. $ 93.00
Temp. ServicefFeeder 201 -400 Amp. $110.00 _......._ -.__ $._.._. ._n.m.._....__,
Temp. Service/Feeder401 -600 Amp. $149.00 _.._._..._..
Temp. Service/Feeder 601 -1000 Amp . $168.00 ,..,._ _._.........
Portal to Portal Hourly $ 96.00 t ...........
Signal Circuit] Umited Energy -1 6.2 Family Dwelling $ 64.00 __._..
Manufactured Home Connection $120.00 ..w. ... $m..._......._........._W.._
Renewable Electrical Energy - 5KVA System or Less $102.00
Thermostat $ 56.00 _ ....... ._.................. ------ ..
Note: $5.00 for each additional T -Stat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. $120.00
Each Additional 500 Square Ft. or Portion of $ 40,00 ..
Each Outbuilding or Detached Garage $ 74.00
Each Swimming Pool or Hot Tub $110.00
Owner as defined by RCWA 9.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months or last inspection.
After reading the above statement, I hereby certify that 1 am the owner of the above named property or a licensed electrical contractor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW, Chapter 19.28, WAC. Chapter 296A613, The City -of fort
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Si g nature of owner, electrical contractor elecWcal administrator: tf«1 t r+„;
ELECTRICAL INSPECTION
WIRING REPORT'
417-4 7135
CORRECTIONS NEEDED:
- - --------
... . . . .....
NOTIFY INSPECTOR WliEN CORRECTIONS
ARE COQ P11 ETED WI! "'111" I 15 IDAYS
uqw q
ELECTRICAL INSPECTION
WIRING REPORT
KS 417 47351
Ca
APPROVED NOT APIFIROVED
ICS -.. -,. ..,.. - -, --, IDITCIN 0
0....... „.....µ.
...... ....... SERVICE .... -- ........... I
IEl.,.,.....- -.,-..,. If::: IIN'AL..,.,, - .,.�,-� El
CORRL mP'M �ENwD ' .. .... d ._._....M� :_ . . ......
,.._........ - - - - --m
NOTIFY IN SPEur Ilf t wiiHi:::lq CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
11DO III