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�,::,oq I'a•efat�ri�atecl �tructures Insi3ection :. .: �� :.
<br /> � �"`�"1,�� Ucp;u•tmenlofConswner.Cl3usinessSer�ices .�70rc��on
<br /> ;.t���.� liuilding Codes Divisiou • 1',3i Ld��e�c:uc� ti1\. Salcm. ���k ❑ \Fashin��tun
<br /> ���-=85" VLiiling address: I'.U. Bn.� I-1�70. S�ilcn�, Ok 9?;(lu_nan-t
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<br /> f�(1_�)37b-308U, Fac i?0_3� 37�-0''^_R.'I�1'1`. uo;� 3?�-13�5 J Uthcr:
<br /> V1�ch: bcd.ura�rni.euc — -
<br /> TYPE OF INSPECTION __ ,.
<br /> U V'isual �J In-plaul �J lu-si.ur �J �pucinl :J (�n site ❑ Out of-statc
<br /> � `_` , ,. �- INSPECTION INFOR�ATION `';, ,,�t ."', . _. ... _ . _
<br /> - -- .. ��. I I r,�ic uf iuspccUuu�. ��'", �D�tic rcqueslcd:_... -
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<br /> Yarq'�o bc billcd: � . j I _
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<br /> Billin�address: � , ✓�i.�
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<br /> Inspcctor namc. I f I;��� ,f ; ; 1�imc in: ! - I Timc ouC i � "1 Insi�iva issucd: ❑l'es Cl tio
<br /> [�Cover ❑ Pinal ❑ Re-inspeclion
<br /> i:.�S -70711�ll10 ❑Y-70G11�11J1 ❑ S -7071i�1190 ❑ 1'- iU6:IlI91 '�5-70711ll90 ❑P-i0611rll9]
<br /> `�n4 7071I1190 ❑ �L 70111,ll91 ❑I�[ 7U711ll90 ❑ '1� -i0!II I1��1 ❑A[ 707111190 �7 'F 701ll 1191
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<br /> ; yi���, e�=T �:.'� �� '" ��.`'.�'',;.� �,;,�.C��, ,INSF?ECTION .REPORT ; M ` �n.. ;: _.._ ,, :.
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<br /> ��Pla��appro�•al no I Senal no.: m~ � OK to cp�er �1�cs ❑No ❑P�
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<br /> In�pcnu s tii, n ilurc: --- _------- -
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<br /> 6t��oicc lo I'ullme hicludc pn}��ucul fur:�ll inspeclions Inspection timc: � - _ �rol<tl Iwu�'s
<br /> performed durin}�c:dcndar muuth. 1'a�mcnt duc 30 Consul�ation: .
<br /> da��s 0•nm billing datc.
<br /> � ' - R'�'r sm�ch:ir�r(slnici mrch): (70711 1'_91) "'� I-huur
<br /> Recci�'ed b�: Dnle: i f - minimum
<br /> � �Cr surch.uec lplumbing): (7061 I 1^_911
<br /> R''� smchxrac (cleeuicnl) :_ _ (70111 L9ll �
<br /> 1�71_I.'ARTMCNT��F
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<br /> �. SERVICES 1'n�e o1�
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