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<br /> �� '�, '�� Ileparl�uenl ol'Consumcr fi Iiusiucss Ser�ices ] Orcgnu
<br /> �� -t�.: 13uildiug Codes Division • 1�3�Jid��c��a�cr'�A1. Salcm. C)k �] \V�ashiu!llon
<br /> �e�'� \I:iilin,� ���dress: Y.O. Bu� 14-170. ti.dcm. �)R 97309-04(i4
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<br /> (iO3)37b-30R0, P.��: (>U3) 3;; 0=^_f;.'1'"fl` ���Lil 3?3-l�;h ] Qtl�cr:
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<br /> TYPE OF INSPECTION
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<br /> ! Y���� ���i' INSPECTION INFORMATION _,,; , ;�.
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<br /> �Covcr '� Pinal ❑Rc-inspection
<br /> OS -70711�1190 ❑P-7061L1191 L1 5 -70711 1190 ❑P-70�II 1191 ❑5 70711119" ..IY-70GI11191
<br /> CI\i-7071111190 ❑*E-70111i1191 '�1\4-70711�ll9(� � "I: -7(�11111��1 ❑V[ 707111190 U 'L' 7011L1191
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<br /> PIa��approval no. S�n.il nu.: OIC to co�u. J 1'ct �No � 1,
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<br /> lu��oicc tu fullme Includc p:���mcnt far all insperlions Inspcclion timc: TOlal iIIUU��s
<br /> performcd durin{�c:dcnd:u•�iiontli. 1'a�'iurnt duc,l0 Consultation: _
<br /> daps�l•om billiu}�datc.
<br /> � . hC� surchar_�c(stnict mcch):_ r711-1I 1'_'Jl) :"� 1-hour
<br /> Recciecd br: . . . ' D:dc: minimum
<br /> 8�"r surch:ugc(plumbii�g):_ (7061 I l'_911
<br /> 8`'r surcl�lrec(cicctric.�): (70111. 1'_911
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<br /> Y►. IXSERVICES _� _
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