20319 92ND AVE W.PDF8895
20319 92ND AVE W
....City, ofEdmoods
C.
-OF-MAY CONSTRUCTION.
JAN - 9 1996 PERMIT Permit Number.
C5 IZ2 /9-1
Lssue Date:
INEtRAI"
ress or Vicinity of Construction: 20319 92nd Avenue W.
GTE to :a, and maintain a buried service
place,, operal
/n C. B. Type of Work (be specific)j-11 re f om exi sti nq Pedestal 0 8190 1 ocated at 20321
92nd Avenue tAen north to a residence at 20319 9Znd Avenue W. GIh to plow feet,
push no driveway, and push no read. R.O.W. Footage 100 feet.
GTE Northwest Incorporated
Contractor: Marilyn Holmqren, Permit Coordinator Contact: Jerry Scott 48/774-5921
2312C W. Casino Rd
Mailing Address: , 981704-1440 Phone: Marilyn 425/710-0786 or 488-1628
State License Liability Insurance: Bond: $
I
D. Building Permit # (if applicable):
E. F1 Commercial El Subdivision
Multi -Family E] 4,�ingle Family
INSPECTOR:
F. Pavement or Concrete Cut
Side Sewer Permit # (if applicable):
n City Project )g] Uti
El Other
INSPECTOR:
0 Yes E]No G. Size of Cut:
. Please see attached !
APPLICANT TO READ A
(PUD, GTE, WNG, CABLE, WATER)
W4. # 2100-9P001D8 642310
x H.
SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division,'771-0220.
Work and 'material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have readhe boz stae79ts and understand the permit requirements and the pink copy of the permit will be
available oblsi)eat rilsti ei for iM&OVrT1077�DurDoses.
C-1 David Squioes Date
orAgent)Section Manager -Access Design
12/31/97
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY.
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY FEE: � rAd
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
T.O.TAL-FEE:
RECEIPT NO.:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION E]YES 13 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
LTEGt,
I
CD
(D
PERMIT SUBMITTED BY
GTE
PEDt. 3
POLES' 0
ROAD 60RES
OVERXFEAD LINES
1.0, UTILITY POTHOi E
UC TRENCMNCV-�:�CT-�
, CUTS.
890 - 199 -
CITY OF EDMONDS STREET FILE LARRY S. NALIGHTEN
250 - 5TH AVE. N. - EDMONDS. WA 98020 - (206) 771-3202 MAYOR
COMMUNITY SERVICES: PETER E. HAHN
Public Works 9 Planning e Parks and Recreation * Engineering DIRECTOR
March 22, 1991
Edwin G. Burrows
20319 - 92nd Ave. W.
Edmonds, WA 98020
Dear Mr. Burrows:
I have reviewed your account and will allow a credit to your account
according to our City policy: the average consumption for the same
period during the previous year charged at normal customer rates, plus
the excess usage charged at the City's cost, plus a surcharge of 15%
applied to the excess only. Only one leak credit will be granted in
any three year period.
Should you have any additional questions, please contact Ilene Larson,
Utility Billing Clerk.
Sincerely,
Ron Holland
Water/Sewer Supervisor
BM/l k
cc: Ilene Larson
Utility Billing Clerk
#409050/TXTWATER
0 Incorporated August 11. 1890 *
Sister Cities International — Hekinan, Japan
FAV�
20319 92nd Ave.W.
Edmonds, WA 98020
March 19, 1991
Water Department
Edmonds Utilities
501 Bell St.
Edmonds, WA 98020
Dear Friends:
Over the past year we have been' noticing a gradual increase in
the cubic feet of water consumed at our house, even though we
have made every effort to conserve. In fact, the latest bill
(11/19/90 to 1/21/91) was -almost twice the amount of one year
ago, even though we'had been away for two weeks during the
most recent period and no water was being used.
An actual leak was not suspected until last Friday (March 15)
when a pool of water appeared in our back yard. -I called the
Water Department immediately and Mr. Scott Highland came.
He was unable to determine the exact location of the leak.
Saturday I called around and was able to secure the services of
a plumber who, however, could not dig.until Monday morning
(today). on digging.down he discovered thd connector between
two sections of pipe had separated. The break may have been
caused by increases in water pres . sure. Rep�airs were made as
described on the enclosed yellow sheet.
We are waiting to see if further repairs might be needed.
M.i�. Highland suggested that I write and req . ues . t some discount on
the next bill or whatever relief might be*appropriate under the
circumstances. We would appreciate'anything you can do.
Sincerely,
Edwin G. Burrows
P.S. The leak'could 'not have been caused by a frozen pipe.
An A Aabco Co.
51a �, -1�00
60 MINUTE MAN%V
P.O. BOX 68773
SEATTLE, WA 98.168
771-1278
282-5563
872-3622
272-8800
DATE
INVOICE no 5 p I
00
CALL NO.
SERVICE PERSON
SVC. NO.
TRUCK #
'N
JOB TELEPHONE
�
—2
GUST. P.O. NO.
I
NUMBER U
V��
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CUSTOMER NO.
.-71FI
CUSTOMER NAME
TYPE
M��
CUSTOMER AGENT
4'1'V
U7
5,
JOB ADDRESS
�'?2
CITY
S
STATE
ZIP
91 ?,-)7
BILL TO
OTHER TELEPHONE
P.R. P.O. NO.
1 L_J SEPTI
J SEPTIC
ADDRESS
STATE
ZIP
GASH CR CARD CH
0 2 3
177
NG REF RESCH
- El
5 SHOWER 8 STORMDRAIN 11 E:1 URINAL 16 [:1 M/L REPIL
E] KITCHEN SINK 3 WASH BOWL 6 TOILET 9 E] POOL DRAIN 12 [-] GREASE TR AP 11 �kR
1 1 13 0 FLOOR DRAIN 8 Fj WH
VOID OTHE C
-F
2 In LAUNDRY LINE 4 BATHTUB 7 E] MAINLINE 10 [:] SEPTICTANK 14 [:) FLOORSINK 19 EJ OTHER
8 n 9 A
[:]R
I E] 100 3 0 700 5 OPIL 7 [:]CAMERA '9'[:] MUSTANG
lzaaim�
IYYS PERIP
IMEM 3 Ej RV 6 FIX
1 El TRAP 4 MH [j],CITHER
2 300 4 1065 6 E] AUG 8 1:1 BIG JET 10 W---ER
7
BLADE: DISTANCE: CABLE:
1 NOF
2 F] C/O 5 O/F
NO,
DESCRIPTION OF SERVICES AND MATERIALS
EST1MATE
I A) e-
LAI -4 :5 Ald 1( V Ll- f,"if 2i erl 6 1 (47 r7l) P
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1,W
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RECOMMENDATIONS: Xr fZZ
CAUSE OF BLOCKAGE:
EXTENDED SERVICES: LABOR $ —2L ---� PER 1A HOUR 0 HRS CABLE $ ER ADDITIONAL CABLE/DRUM
NO.
QTY�
PRODUCT
AMOUNT
f
SERVICE
DRAINRIGHT,
MATERIALS
SUB TOTAL
S-v
Z/
SALES TAX
7
V
-..MATER[&.LIST
ATTACHED
ESTIMATE
TOTAL
TOTAL MATERIALS
PLEASE PAY
THIS AMOUNT
cff
OM
I am the owner of the property or his duly authorized agent. I have used no chemicals in �h—e drain system within the last 48 hours
except (if none, enter "none").
The estimated price does not include sales or other tax, if any, nor cover unforseen parts or labor which may be needed after the work begins. Written
customer authorization will be obtained before beginning any additional or extended work.
I authorize the performance of the work, subject to all the terms and conditions set forth on the face and reverse side hereof, plus any taxes upon comple
tion. This invoice is tie an�payable upon receipt.
ORIGINAL
"'k 11 1 ADDITIONAL
C9
ESTIMATE $4 WORK $ x
SIGNATURE TITLE INITIALS"�
0
ADDITIONAL $ X ACTUAL
WORK WORK $ L'IGN;AM—RE
INITIALS
YOUR SAMSFAC70N �S OUR HGHEST PR�ORITY�
PROBLEMS OR QUES7ONS? LET US KNOW� WE WANT TO MPROVE.
SEE IMPORTANT INFORMATION ON REVERSE SIDE c COPYRIGHT RESCUE INDUSTRIES 1989 0 M
ESTIMATE COPY
TERMS AMD G rJ\\'1L-L1)ff1111Q:VM8
IF THIS INVOICE IS NOT PAID OR, IF PAID BY CHECK AND THE CHECK IS DISHONORED OR RETURNED FOR ANY REASON, YOU ARE AUTHORIZED TO CHARGE
THE AMOUNT SHOWN ON THE FACE HEREOF, PLUS A $15.00 FEE, TO THE CREDIT CARD BELOW:
VISA — M/C— CARD # EXP— .
(signature)
RESPONSIBILITIES AND REPRESENTATIONS OF CUSTOMER - Customer represents that all water and waste disposal systems are in good repair and
condition and agrees to hold Rescue Rooter ("Company") harmless for the discovery of any of the following defective conditions:
1. Leaky or defective traps
2. Hidden or unknown lead piping
3� Improper or faulty plumbing
4. Rusted or defective pipes
5. Corrosion or unusual restrictions due to minerals or hard water buildup
6. Cleaning chemicals such as lye, sulfuric acid, etc.
7. Lines which are settled, broken, deteriorated, or damaged
8. Existing illegal conditions
9. Defective roofing
Customer shall indicate all property lines and customer authorizes access through other properties for company's use during work, customer is
required to obtain permission therefor and agrees to be responsible for and to hold Company harmless from any risks thereof.
Customer shall secure work site and prevent entry thereon by children and animals.
Customer is required at his expense to do all work and other acts to meet all conditions necessary to allow Company to complete the work as
provided in this Agreement.
RESPONSIBILITIES OF COMPANY — CONDITIONS AND LIMITATIONS - Company shall do all work in a good and workmanlike manner, however, this
responsibility shall not create any obligations which would expand Company's obligations under the limited warranty.
Company is not responsible for any existing illegal conditions.
Company is not responsible for any damage caused by the removal of the cleanout cap or drain cover. If, in the opinion of Company, a cleanout
cap, drain cover or housing is so rusted, broken, or fastened as to require its replacement after removal, Company shall notify Customer. If Customer
authorizes replacement thereof, it shall be made at an additional charge. If Customer refuses to authorize replacement, Company shall not be responsible
for damages thereafter resulting from sewer gas, back ups, or other leaks through such cap, cover, housing or opening caused by rain or other causes.
Company is not responsible for toilets damaged during cleaning unless so indicated on face thereof.
LIMITED WARRANTY - Company warrants its work to be free from defects in material and workmanship for the warranty period set forth on the face
hereof. All warranties are void if payment is not made when due.
Warranties hereunder extend only to Customer and are not transferrable.
If a defect in materials or workmanship covered by this warranty occurs, Company will, with reasonable promptness during normal working hours,
remedy the defect. In no event shall Company be held liable for water or other damage caused by any delay in remedying a defect.
To obtain warranty performance notify Company of any defect or claims for breach at the address and telephone number on the face hereof or
telephone national headquarters at 1-(800) 824-7233 (INSIDE CALIFORNIA) or 1-(800) 325-7233 (OUTSIDE CALIFORNIA)
EXCLUSIONS AND LIMITATIONS: CUSTOMER'S RIGHT TO REPAIR AND REPLACEMENT ARE THE EXCLUSIVE
REMEDIES AND COMPANY SHALL NOT BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES RESULTING
FROM THE MATERIALS PROVIDED FOR IN THIS AGREEMENT
Company is not responsible for the following which are excluded from the coverage of this limited warranty:
1. Commercial or industrial waste lines unless so indicated on the face hereof.
2. Defective conditions listed under the above "Responsibilities and Representations of Customer."
3. Work performed by or materials installed by others not in this Agreement.
4. Defects and failures from mistreatment or neglect.
5. Defects and failures from intervening causes including, but not limited to, improvement causing heavy weight upon sewer lines and plantings growing
into sewer lines,
6. Removal of excess root penetrations which cannot be removed by typical sewer cleaning equipment, but require special heavy equipment.
This limited warranty is the only express warranty Company gives. IMPLIED WARRANTIES, including, but not limited to, warranties of merchantibility and
fitness for a particular purpose, are limited to a duration of 60 days from the date of completion.
PROTECTION OF CLISTOMER'S PROPERTY - Customer agrees to remove or to protect any personal property, inside and out including, but not limited to, carpets,
rugs, shrubs, and plantings, and Company shall not be held responsible for said items. Nor shall Company be held responsible for the natural consequences
of Company's work which may cause damage to improvements to real property including, but not limited to, curbs, sidewalks, walks, driveways, garages, patios,
lawns, shrubs, sprinkler systems, and other appurtenances to the residence of other real property.
Company shall not be held responsible for damage to personal property, real property, or any improvements to real property, caused by persons delivering
materials or equipment or keeping gates and doors closed for children and animals.
ATTORNEYS' FEES - If an arbitration or an action at law or in equity, including an action for declaratory relief, is brought to enforce or interpret the provision
of this Agreement, the prevailing party shall be entitled to reasonable attorneys' feeslin addition to any other relief to which the prevailing party may be entitled.
ENTIRE AGREEMENT - This is the entire agreement The parties are not bound by any oral expression or representation by any agent purporting to act for
or on their behalf or by any commitment or arrangement not set forth herein. The agreement binds jointly and severally all signing as Customer, their heirs,
representatives, successors and assigns.
Owffig 809
NATIONAL HEADQUARTERS
-N/yogoff 0000 ffN
(800) 824-7233 (INSIDE CA)
(800) 325-7233 (OUTSIDE CA)
STREE-T FILE I
CITY OF EDMONDS LARRY S. NAUGHTEN
250 5th AVE, N. * EDMONDS, WASHINGTON 98020 9 (206) 771-3202 MAYOR
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
January 9, 1986
Resident
20210-92nd Ave. W.
Edmonds,':WA 98020
Dear Resident:
The City of Edmonds Water Section has recently installed a water
valve to help improve the water pressure and fire flows in your area.
Since some of the residents on top of the hill have had low pressure in
the past, the new valve will eliminate this problem.
Currently, the pressure in the area is 35-40 P.S.I. and now will
range from 95 to 105 P.S.I. The City does require a pressure reducer
valve at the house, however, since some of the existing houses may not
have a pressure reducer valve, you are required to install one to
protect against possible leaks due to the change in pressure.
This is a relatively inexpensive item (between $45-$50) and it may
be adjusted to control the pressure in your house. The pressure
reducing valve should be installed prior to April 30, 1986.
If you have any questions, please feel free to call the Water
Section at 771-3202, extension 293 or 291.
Sincerely,
ACHIE BRENA
Water/Sewer Section Supervisor
AB/ml
�17 Q(
ILLS D T -H'—I G �HL 4A 4T �MA CH 0 P
PUBLIC WORKS PLANNING PARKS AND RECREATION ENGINEERING
0
NOTICE:
--a -r-r a n ty.. .0 T -a-uk, U. 10 U Y.
N'O*'*w
The information 'shown on the attached
map(s) was coMpiled for use by the City of
Edmonds/ its Employees and Consultants.
Th,..e City of *Edrn.onds does. not. warrant the
n these
accuracy of anything set for.th o . -
rnap(�). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding th-e infcbrrn-ation shown or
-map(s), including, but not Hmited to, I
-er stub shown. Suc
the lotation of any sew
sewer stubs may or may- not exist and may
or may not exist at the location shown.
Neither the city of Edmo-nds, nor its
em pl-o-yee-s o,r officers -s-h-a-1.1 be l--J a-b-Ife for the
n on this map(5), nor for
information give'
any one representation provided based
upon said map(s),
m
Side Sewer Drawing
The City of EdmoncSTREET FILE EASEMENT NO.
NEW CONSTRUCTION f-1 REPAIRS LID NO -- ------- ------------ - ASMT. NO - ------------------
OWNEP - ----- ------
q"
.. .............. CONTRACTOR -- ---------------------------------------------------- PERMIT NO.
JOB ADDRESS .....
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
................... .............................................................................. ...............................................................
NAME OF ADDITION ...... F�0C.-I�APt:i ...
---------------------------------------------------- --
-5. —=1.
Approved:
PWW-0001-11/75 (REV.11178) DATE
..........
C/
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W
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04
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CITY OF EDMONDS
`�UBLIC WORKS DEP
SIDE SEWER PERMIT
FOR INSPECTION CA.*
775-2525 Ext. 220
0 -09
Permit ,,jo
Issue Date
* PERMIT MUST BE POSTED ON JOB SITE *
1. Address of Construction I F5 5Z,_,o AUE- wj
2. Property Legal Description (include all. easements)
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder Zi-lelt> _4Z:F-IM11,;�S —Scl-Wo
5. Contractor .& License No.
6. Invasion into City Right -of -Way No Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property:...Yes No Easement required -
attach legal description and county easement7 number.
READ THE FOLLOWING AND SIGN:
a. Property owner all side sewers on
0"I F 7w-r m *
their property. A lic Spon st be employed to
construct side sewers
b. The side sewer assum s f o sibility for each
installation for one y
C. Commercial est u, e imum of a six inch (6")
side sewer line.
d. Side sewers ma b s 1 d tha thirty inches (30")
to any structure
e. Side sewer line 0
.�u t min' ade of 2% (1.15
and maximum grade of 10 0
f. No turn in side s8wer greater than 45 (1/8ibend) is allowed
between cleanout. All 90 turns must be constructed of a 45 0 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right -.of -way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.- Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: r7- 1 (7- -2 1
E�_Ti L4)(61T9,:0
PERMIT FEE:
CONNECTION FEE:
0
rX4 PERMIT MI
I certify/that I have read .
and shall comply with the above
DISAPPROVED BY: Date:
By: -Date:
APPROVED By: -.5.
Date
T BE POSTED ON JOB SITE
STREET FILE
CITY OF EDIVIONDS HARVE H. HARRISON
MAYOR
200DAYTON ST. -EDMONDS. WASHINGTON 98=-(206) 775-2525
DEPARTMENT OF PUBLIC WORKS
December 28, 1979
Mr. Chris Peters -Senn
20319 92nd Avenue West
Edmonds, Washington 98020
Dear Mr. Peters -Senn:
SUBJECT: SIDE SEWER PERMIT 6353 - 20319 92nd Ave. W.
You were issued subject permit for installation of
• side sewer on July 7, 1979. To date we have not received
• request for a final inspection.
Please complete installation and request a final
inspection by January 31, 1980, or I will cancel your permit.
If you have any questions regarding this matter, please
call Jim Roberts or Doug Johnson at 775-2525, ext. 220.
Sincerely,
A S.. ADAMS, P.E.
City of Edmonds
DAG/jky
0
-7 4
CITY of EDMONDS
BLOESS
LICENSE APPLICATION D LICENSE
NO.
Civic Center Edinonds, Washington 98020
City Clerk Phone 775-2525
ANNUAL FEES
PENALTY AFTER FEB. 15
4a
HOME OCCUPATION
INSTRUCTIONS'
CLA
YEAR
E qHW%,
0AS(V 1-11.6a
$10.00 (A)
ADDITIONAL $5.00 0
Tj
7 ;r
I
* All items must be completed
I
I I
I I I 1
0 SMALL BUSINESS
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINTX A6-
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
C) L,� A
IN SIEC- IX
FOR ISSUE OF
0 Business*with 10 or
* Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
-)2" 1
I 1 : I
LICENSE WITH
'LC' ACTION.
$50.00 (C)
after February 15 must pay
0, NEW APPLICATION (LA)
penalty in addition to fee.
11 RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 1/2 FEE,
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
. NAME OF FIRM
BUSINESS PHONE
NO. 0 EMPLOYEES
2? 72 zl� 76-
MAILING ADDRESS NATURE OF BUSINESS
z111/ .1 -/11
BUS!1NESS,,,ADDRESS--
INDI VJDUAL
PARTNERSHIP CORPORATION
EjZf (S)
(P) P
OWN�-ERS-N-9M-
�7 ZZ Z�
HOME ADDRESS
)(2
HOME PHONE
7;7,:�
DATE OF
B-IRTH'-
-7 1��-
5C rl H
e
SOCIAL SECURITY NUM R
-7-
EMERGENCY NOTIFICATION:
(1) NAME & TELEPHONE
-7 7,!�
(PLEASE LIST -TWO)
(2) NAME & TELEPHONE
WASHINGTON STATE TAX NO.Z� ';�YIZP&11 APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
��A PROVE 0 DISAPPROVE
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
ILDING DEPARTMENT DATE
APPROVE .11 DISAPPROVE
SIGNATURE.
COMMENTS: t U PATIO Ij -. S/F=
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
Building
El
Hotel/Motel
(L)
Permit
0
0
Apt. Bldg.
Office Bldg.
(A)
(0)
Occupancy
El
Restaurant
(R)
Grou
0
Hosp/Nurs Home
(H)
0
School
(S)
FIRE DEPARTMENT DATE U. F. 1. R.
0 APPROVE V DISAPPROVE SIGNATURE
COMMENTS: C?#aC4Qj
PO�PE DEPARTMENT
&�'-APPROVE DATE/-/ 2e SIGNATURE
COMMENTS: 0 DISAPPROVE
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS-