10140 SW WASHINGTON SQUARE (1) 10140 SW Wushinyton Square Rd •
1S1 35BA 100
retail sales - Store front
(The Paper Station)
Building B Space B-1
57156 - kT
retail sales
57155 /4-6
4
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INSPECTION NOTICE
DATE 1I ik X
OWNER --._ ... --- — —
OCCUPANT • _ _ __ _ OCCUPANCY —L +41 S/ A,
LOCATION _T____ — - l —"
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FINE MARSHAL
WASHING ION COUNTY FIRE DISTRICT NI
20056 S.W. BLANTON STREET
PRESENTED To__ -- ----
I
ALOHA.ORFOON 9700!! 649.8577
,ON •n0 4n
I
i) fie-- 'l iss
�~
Washington County Fire District No. 1
.- 7 20M5 S.W. tIlantoa Street
` � '
s/ Aloha, Oregon 97007
Bureau of Fire Presention
649-8577
Plans Examination Repot! No. _ ..
10006
'' _4069 & 4189
Count; Kin No.
AT-r$.i • 'le
Pa_er StLt.Qd Occupancy
Building _ - --------- --
Address ._.]_Q1 .-_LAI„. Wast1111QtOD_SQWiXe. RDdl- --Construction Type-- V-N- --_
Architect'Designer ._ Address -----
Wintnar Pacific Address .9585 S. W^WWashington_Square Road_
Owner__._.___.---___ .-
1 %.''.) 5 ft. Basement Area n!8 _____-- Attic Fidght,_-nim
Stories 1 _Pint Scor} Area s q
n a I sits 2 ._ and Total Width___9 f ts__ ;
Draft Stops n�a_. __ Fite Walls /
Stairs____nLii_-.__/Fnclrned_. '” Other Vertical hafts
n/d -'Enclosed- —_- __Sprinklers.__.Y.et._ ._
Area Covered __ full _
Manual Alarm of a -.Standpipes_..—li--
_ _._ -- _ --- -
Combustion Detection __.n/d /Type - _ _ ---- -
Area c to red
Floor _ concrete _ Ceding Suspended. Roof__-__ staff &LIS .11...f'•
Ste.Members wood/steel
Wall Cos er tt•III GDncre_t _.block __ (Int.) 2p-111111
Heating System heat rump
hid gas Cooling System —
The plans for the atoll described •roject were referred to Opts office
July 17, 1984,
and reviewed .__.,JJ-t)-.� "25, 9°4, _--for conformity with State and District fire safety saws and regulations.
Listed as follows are applicable requirements for which we have fo end no provisions in our examination of the drawings,
general pores and/or sprrifrrations.
1 . Exit doors shall swing it the direction of exit travel , that is, out. ( nit doors
shall be openable from LPe inside without the use of a key or any special know-
ledge or effort. This requirement shall not apply to the exte, ior doors of this
t occupancy if there is a readily visible, durable sign on or adjacent to the door
staling "THIS DOOR TO REMAIN UNLOCKED • '1RING BUSINESS HOURS.' The sign shall be
in letters not less than 1 inch in height on a contrasting background. The
locking device must be of a type that will he readily distinguishable as locked.
Richard n Batu , CONTINUED
Fire Man C 7 ,
//
/ Fite Prevention Olney
cc: Jeaneine Fyllingness
,.Yash. Co. Bldg. Dept. (2)
Wilburn Dodge
Form 900/3 District Inspector
Revised 1043
•
Plans Examination Report No. 100006
Paper Station
rage 2
Manually operated edge or surface-mounted flush bolts and surface bolts are
prohibited. When exit doors are used in pairs; approved automatic flush bolts
are used, the door leaf having the automatic flush bolts shall have no door
knob or surface-mounted hardware. The unlatching of any leaf shall not require
more than one operation.
(ref: Sec. 3304 U.B.C. )
2. Exit signs shall be installed at required exit doorways. Words on the sign
shall be in block letters 6 inches in height with a stroke of not less than
3/4 inch. Signs shall he internally or externally illuminated by two electric
lamps or shall be of an approved self-luminous type. Main exterio- exit doors
which c:bviously and clearly identifiable as exits need not be signed when
approvel by the Fire Marshal.
(ref: Sec. 3314 U.B.C. )
3. All insulation materials including facings, such as vapor barriers or breather
papers, installed within floor-ceiling assemblies, roof-ceiling assemblies,
walls, crawl spaces or attics shall have a flame-spread rating not to exceed
25 and a smoke density not to exceed 450 when tested in a:'cordance with U.B.C.
Standard No. 42-1 .
(ref: Sec. 1713 U.B.C. )
4. Address shall be provided
on the building in such a position as to he plainly
visible and legible from the street or road fronting the property.
(ref: Sec. 513 U.B.C. )
5. Inspection is required after all framing, fireblocking and bracing are in
place; all electrical , plumbing and other utilities have been installed and
prior to the installation of gypsum wallboard sheeting and upon completion
and prior to occupancy.
(ref: Sec. 305 U.B.C. `
6. A Certificate of Occupancy is required from the Washington County Building
Department.
(ref: Sec. 307 U.B.C. )
SPECIAL. NOTICE:
DEVIATIONS FROM THE SUBMITTED AND HEREBY CONDITIONALLY APPROVED PLANS DURING
THE COURSE OF CONSTRUCTION, EXCLUSIVE OF THOSE NECESSARY TO COMPLY WITH FIRE SAFETY
REQUIREMENTS AS LISTED HEREIN, ARE PROHIBITED WITHOUT THE WRITTEN AUTHORIZATION OF
THE WASHINGTON COUNTY BUILDING DEPAPTMENT AND THIS OFFICE.
PLEASE NOTE THAT WE HAVE PROVIDED A REFERENCE FOLLOWING t.ACH REQUIREMENT.
THIS NOTE INDICATES THE APPLICABLE CODE AND SECTION THEREOF IN WHICH THE REQUIREMENT
IS CONTAINED. U.B.C. , U.M.C. AND U.F.C. REFER TO THE UNIFORM BUILDING, UNIFORM
1/
Plans Ecamination Report No. 10006
Papor Station
Page 3
MECHAF ..CAT ANC UNIFORM FIRE CODES RESPECTIVELY AS ADOPTED AND AMENDED BY WASHINGTON
COUNTY FIRE DISTRICT NO. 1 . PLEASE CONTACT THIS OFFICE IF THERE IS ANY REQUIREMENT
WHICH YOU QUESTION OR DO NOT UNDERSTAND.
1
6.
•
PW A NNWG D COUNTY
TME � /7/ 0 F.M. DCT, FILE
PLANidiNG DEPARTMENT - BUrIDNG DIVISION `� f :
NON-STRUCTURAL. -- ❑COATII.
DATE MAI ll a_
PLAN CHECK
L
BUILDING Washington Square Too, Bldg. B, Space 1. �_
ADDRESS, ►.0150 SW Washington Square Road PH.NO. 63y-r___ _
OWNER _ _W.i! Pacific, i_n_ _L______ — _
ADDRESS _ 9585 SW Washir.nton Sguare Road, Portland OR 97223 __— __________
y
ARCHITECT/ENGINEER Jeaniere_Fyllingness, Tenant Coordinator _PH.NO. ----
Ar,-REBS As Above ///8? -- — — — FIRE
PERMIT 0 A 7/54;ELAN CHECK 0 0E9_OCCUP. B-2 CONST._ VN _ DIST. Wushinoton County Nl
LOCATION ON PROPERTY: North South ____—_____ East Jost—West
STREETS: North------- South` East__,__.
REQUIRED FIRE RESISTIVE RATINGS: Exterior Walls —No Change ____
MATERIALS Roof Existing
Structural Members Existing _ _-
Exterior Walls Cover Store Front - Masonry Interior Walls Gyw1 Boars'_- Meta► S..uds
Sus)epi ied Floors Concrete
Ceilings
6ASIC MAXIMUM AREA: ___
Max. Height - Max. No. Stories
----
Flax.Increase mor-Yards, Sprinklers
— Yes_—
TOTAL ALLOWABLE_ No Change
BUILDING USE: Fc tail Saies _ "The Paper Station" West end of Building B _
BUILDING AREA: 3rd Floor _
Basement __ _ __ . 1st Floor__1842 2nd Floor ____ ,___
HR RATINGS HR RATINGS
AREA SEPARATION _ None HR RATINGS �
OCCUP.SEPARATION None � OPENINGS HR RATINGS __ OPENINGS
CORRIDOR CONST. Non-Rated ATTIC DRAFT STOPS Not Shown FLOOR CEILING DRAFT STOPS
STAIRSNorge WIDTH ENCLOSED ---
OTHER VERTICAL SHAFTS None — ___, — ENCLOSED—__-____________..
EXITS REQUIRED: No. ____ Two WIDTH 6' J"WIDTH^____ WiTn _
___
EXITS PROVIDED: No. -- �— No
EXIT ILLUMINATION REQUIRED Yes SEPARATE CIRCUITS
EXIT SIGN REQ. Yes ILIUMYes SEPARATE CIRCUITS. No TWO POWER SUPPLY No
_- .� Not Shown
Yes ELEVATOR___. _ RAMPS_ ._
HANDICAPPED ACCESS REQ.__ _ COOLING SYSTEM
HEATINa Not Shown __ FUEL _�_____-____— `—
• The plans for this project were received by this office on 6-5-84 ___ �ndQeg�mined f orsthe
te
non-structural , fire and life safety portion of the plans review on
on the back of this sheet are the items we find to be in violation of, PF—for_wFich we find
no provisions for the requirements of the 1982 Edition of the State Uniform Building Code.
(Over)
9/83
f..
1. Retail sales areas with an area exceeding 1500 square feet and located on the ground
floor of a building must be calculated as having an occupant load exceeding 50 persons.
Table 33-A requires that a retail sales area with an occupant load of more than 50 be
provided with two separate exits. Exit doors which serve as required exits serving an
occupant load of more than 50 must swing in the direction of exit travel . Reference
Section 3304, S.B.C.
2. Exit doorways other than the main exit doorway must he provided with illuminated exit
signs to clearly indicate the direction of exit travel . Reference Section 3314, S.K.C.
3. A floor or landing must be provided on each side of doors. The floor landing shall riot
be more than 1/2 inc ! lower than the threshold of the doorway. When doors open over
landings, the landing must have a length of not less than five feet. Reference Section
3304, S.K.C.
4. Doors must be fitted with a type of locking or latching device which will permit the
opening of the door from the inside without the use of a key, special knowledge or
effort, except that exterior exit doors may be fitted with a keyed locking device which
is readily distinguishable as locked and there is a readily visible, durable sign on or
adjacent to the door stating this door to remain unlocked during business hours.
5. Draft stop, shall be installed in attics, mansards, overhangs, false fronts set out from
walls and similar conc- iled spaces of buildings so that the area between draft stops
does not exceed 3,000 square feet and the greatest horizontal dimension does not exceed
60 feet.
Where approved automatic sprinklers are installed, the area between draft stops may be
9,00° square feet and the greatest horizontal dimension may be 100 feet.
Draft stop construction. Draftstopping materials shall be not less than 1/2 inch gypsum-
hoard, 3/8 inch plywood or other approved materials adequately supported.
Openings in the partitions shall be protected by self-closing doors with automatic
latches constructed as required for the partitions.
Ventilation of concealed roof spaces shall be maintained in accordance with Section 3205,
S.K.C.
6. Glass used in doors or in glazing located within 12 inches of the nearest vertical edge
of a door or in areae subject to human impact, shall he tempered or of an approved
safety glaring material . Reference Section 5406, S.K.C.
7. In lieu of submitting an engineers design, suspended ceilings and fixtures shall he
supported as specified in U.K.C. Standard 47-18 and shall be laterally braced as shown
on the attached cross section. Additional information of standard requirements is avail-
able if needed upon request.
O. Complete mechanical system plans for the IIVAC equipment and duct work must be suhmitted
and approved by this office prior to such installation. Reference Section 302, S.M.C.
9. Plans for the installation or alteration of the automatic sprinkler system must be pro-
vided to and approved by Washington County Fire District 01 prior to such installation
or alteration.
10. Subject to the above listed items, the plans for this project are approved for construc-
tion, insofar as the Washington County Building Division requirements apply.
Jim Schroeder
Plan. Examiner
JS/jabs
G
1
•
/' T \ County •
Washington CFire District No. 1
. � 20665 S.W. Blanton Street
Aloha, Oregon 97(107
)/ S S
Bureau of Fire Presentinn /S'
M9-!4577 5
Plans Fsarnination Report No 10006
County Plan No. 4069 & 4189
Building Paper `,cation Occupancy B-2
Address_ ._1p140 S. W. Washington Square Road Construction Type_,V-N_.
Architect/Designer Address
Owner Wirrnar Pacific Address 9585 S. W. Washington Square Road —
Stories 1 .,__First Story Area 1 ,726 sq.ft. Basement Ales _pia ._Attic Height
Draft Slops 1a Fire Walls Ola .Exit; �. ?_� and Total Width 9 fLi -•---
Stairs_- nja /Fndosed '- Other Vertical Shafts_ 1a_ JEnclosed ._"__ ____$1'rinklets__yes
Area Covered full Manual Alarm IlId ___Standpipes___llL.a__-_ ,^ —
ComHu,tion Detection n/a /Type -' ..Area Covered ----
Fluor _concrete ceiling suspended Rom and_LUL ._____
Str.Members ___ wood/Steel wan Cos ec(Ext.)..___cane tehLuG1C--J(Int.). Slyp.SLIC _�
Heating System heat pump Fuel aS ________Cooling System. _ ---- -- —
The plans for the ahoy descrih4d_eroject were referred to tha office
and reviewed __ Ju25, 19H4,� _ -for conformity with Slate and District fire safety laws and regulations.
listed as follows are applicable requirements for which w( have found no provisions in our examination cf the drawings,
general notes and/or specifications.
1 . Exit dpors shall swing in the direction of exit travel , that is, out. Exi': doors
shall be openable from the inside without the use of a key or any special know-
ledge or effort. This requirement shall not apply to the exterior doors of this
occupancy if there is a readily visible, durable sign on or adjacent to the door
stating "THIS DOOR TO REMAIN UNLOCKED DURING BUSINESS HOURS." The sign stall be
in letters not less than 1 inch in height on a contrasting background. The
locking device rust be of a type that will be readily distinguishable as locked.
Richard D. !Wits CONTINUED
Fire Marshal i
Fire Presenticm officer
cc: Jeaneine Fyllinyness
4sh. Co. Bldg. Dept. (2)
Wilburn Dodge
Form 900/3 Distri t Inspector
Re.lsed 10411
1
ill!!
Plans Examination, deport No. 10006
Paper Station
Page 2
Manua:1y operated edge or surface-mounted flush bolts and surface bolts are
prohibited. ,.hen exit doors are used in pairs , approved aut amatic flush Dolts
are used, the door leaf having the automatic flush belts shall have no door
knob or surface-mounted hardware. The unlatching of any leaf shall not require
more than one operation.
(ref: Sec. 3304 U.B.C. )
2. Exit signs shall be installed at required exit doorways. Words on the sign
shall be in block letters 6 inches in height with a stroke of not less than
3/4 inch. Signs shall be internally or externally illuminated by tiro electric
lamps or shall he of an approved self-luminous type. Main exterior exit doors
which obviously and clearly identifiable as exits need not be signed when
approved by the Fire Marshal.
(ref: Sec. 3314 U.R.C.)
3. All insulation materia's inrluding facings, such as vapor harriers or breather
papers, installed wits. fluor-ceiling assemblies, roof-ceiling assemblies,
walls, crawl spaces or ,ttics shall have a flame-spread rating not to exceed
25 and a smoke density rot to exceed 450 when tested in accordance with U.B.C.
Standard No. 42-1 .
(ref: Sec. 1713 U.B.C. )
4. Address shall be provided on the building in such a position as to be plainly
visible and legible from the street or road fronting the property.
(ref: Sec. 513 U.B.C. )
5. Inspection is required after all framing, fireblocking and bracing are in
place; all electrical , plumbing and other utilities have been installed and
prior to the instal1':ion of gypsum wallboard sheeting and upon completion
and prior to occupancy.
(ref: Sec. 305 U.B.C. )
6. A Certificate of Occupancy is required from the Wa',hington County Building
Department.
(ref: Sec. 307 U.B.C.. )
SPECIAL NOTICE:
DEVIATIONS FROM THE SUBMITTED AND HEREBY CONDITIONALLY APPROVED PLANS DURING
THE COURSE OF rONSTRUCTI'JN, EXCLUSIVE OF THOSE NECESSARY TO COMPLY WITH FIRE SAFETY
REQUIREMENTS AS LISTED HEREIN, ARE PROHIBITED WITHOUT THE WRITTEN PUTHORIZATiON OF
THE WASHINGTON COUNTY BUILDING DEPARTMENT AND THIS OFFICE.
PLEASE NOTE THAT WE HC.VE PROVIDED A REFERENCE FOLLOWING EACH REQUIREMENT.
THIS NOTE INDICATES THE APPLICABLE CODE AND SECTION THEREOF iN WHICH THE REQUIREMENT
IS CONTAINED. U.B.C. , J.M.C. AND U.F.C. REFER TO THE UNIFORM BUILDING, UNIFORM
9
Plans Examination Report No. 10006
Paper Station
Pa ;e 3
MECHANICAL AND UNIFORM FIRE CODES RESPECTIVELY AS ADOPTED AND AMENDED BY WASHINGTON
COUNTY FIRE DISTRICT NO. 1 . PLEASE CONTACT THIS OFFICE IF THERE IS AN1 REQUIREMENT
WHICH YOU QUESTION OR 00 NOT UNDERSTAND.
v
WASHINGTON COUNTY iNS►. ❑ AFIC".
PLANNING DEPARTMENT - BULDNG DI"iS1oN ❑ F.M. 0(TY IiIE
NON-STRUCTURAL ❑COR
PLAN CHECK DATE MAILED -_
BUILDING Weshington Square Too, Bldg. B, Space i
ADDRESS __ 10150 SW Washington Square Road
OWNER Winmar Pacific, Inc. _ PH.NO. 639-1360
ADDRESS 9585 SW Washington Square Road, Portland, OR 17221-----
_
ARCHITECT/ENGINEER Jeaniene Fyllingness, Tenant Coordinator PH.NO.
ADDRESS As Above
-- — /// q --- - -- — ---- FIRE
PERMIT 0 PLAN CHECK �i069 OCCUP. B-2 CONST. VN DIST. Washington County 01
LOCATION ON PROPERTY: North __ South -- _ _ East West
STREETS: NorthSouth —East West
REQUIRED FIRE RESISTIVE RATINGS: Exterior Walls No Change
MATERIALS:
Structural Members Existing Roof Existing
Exterior Walls Cover Store Front - Masonry Interior Walls Gypsum Board - Metal Suds
Ceilings Susaen;'ed Floors Concrete J --
BASIC MAXIMUM AREA:
Max. Height Max. No. Stories
I11x. Increase for Yards Sprinklers Yes
TOTAL ALL(WABLE No Cnange
BUILDING USE: Retail Sales - "The Paper Station" West end of 3uildina B
BUILDING AREA:
Basement 1st Floor 1842 2nd Floor 3rd Floor _
AREA SEPARATION None HR RATINGS OPENINGS HR RATINGS
OCCUP.SEPARATION None HR RATINGS OPENINGS HR
CORRIDOR CONST. Non-Rated ATTIC DRAFT ST,P$ Not Shown FLOOR CEILING DRAFT STOPS
STAIRS None WIDTH ENCLOSED
OTHER VERTICAL SHAFTSNone ENCLOSED
EXITS REQUIRED: No. ___ Two WIDTH 6' 3"EXITS PROVIDED: No. -Two WIDTH RoW Shown- — —�--- —
EXIT ILLUMINATION REQUIREi) Yes SEPARATE CIRCUITS No
EXIT SIGN REQ. Yes ILIUM.__ Yes SEPARATE CIRCUITS iso TWO POWER SUPPLY No
HANDICAPPED ACCESS REQ. Yes ELEVATOR RAMPS Not Shown
HEATING Not Shown FUEL COOLING SYSTEM_
• The plans for this project were received by this office on 6-5-84 and examired for the
non-structural , fire and life safety portion of the plans revs ew ons-19-84 . Listed
or the back of this sheet are the items we find to be in violation uf, or for which we find
no provisions for the requirements of the 1982 Edition of the State Uniform Building Code.
9/83 (Over)
1. Retail sales areas with an area exceeding 1500 square feet and located on the ground
flour of a building must be calculated as having an occupant load exceeding 50 persons.
Table 33-A requires that a retail sales area with an occupant load of more than 50 be
provided with two separate exits. Exit doors which serve as required exits serving an
occupant load of more than 50 must swing in the direction of exit travel . Reference
Section 3304, S.B.C.
2. Exit doorways other than the main exit doorway must be provided with illuminated exit
signs to clearly indicate the direction of exit travel . Reference Section 3314, S.B.C.
3. A floor or landing must be provided on each side of ouors. The floor landing shall not
be more than 1/2 inch lower than the threshold of the doorway. When doors open over
lindings, the landing must have a length of not less than five feet. Reference Section
3304, S.B.C.
4. Doors must he fitted with a type of locking or latching device which will permit the
opening of the door from the inside without the use of a key, special know edge or
effort, except that exterior exit doors may be fitted with a keyed locking device which
ir- readily distinguishable as locked and there is a readily visible, durable sign on or
adjacent to the door stating this door to remain unlocked during business hours.
5. Draft stops shall be installed in attics, mansards, u••'trhangs, false fronts set out from
walls and similar concealed spaces of buildings so that the area between draft stops
does not exceed 3,000 square feet and the greatest horizontal dimension does not exceed
60 feet.
WPcre approved automatic sprinklers are installed, the area between draft stops may be
9,000 square feet and the greatest horizontal dimension may be 100 feet.
Draft stop construction. Draftstopping materials shall be not less than 1/2 inch gypsum-
board, 3/8 inch plywood or other approved materials adequately supported.
Openings in the partitions shall be protected by self-closing doors with automatic
latches constructed a.. required for the pa i.i ons.
Ventilation of concealed roof spaces shall be maintained in accordance with Section 3205,
S.B.C.
6. Glass used in doors or in glazing located within 12 inches of the nearest vertical eage
of a door or in areas subject to human impact, shall be tempered or of an approved
safety glazing material . Reference Section 5406, S.B.C.
7. 1r lieu of submitting an engineers design, suspended ceilings and fixtures shall be
supported as specified in U.B.C. Standard 47-18 and shill he laterally braced as shown
on the attached cross section. Additional information of standard requirements is avail-
able if needed uron request.
8. Complete mechanical system plans for the HVAC equipment and duct work must be submitted
and approved by this office prior to such installation. Reference Section 302, S.M.C.
9. Plans for the installation or alteration of the automatic sprinkler system must he pro-
vided to and approved by Washington County fire District /'l prior to such installation
or alteration.
10. Subject to the above listed items, the plans for this project are approved for construc-
tion, insofar as the Washington County Building Division requirements apply.
Jim Schroeder
Plans Examiner
JS/jabs
10140 SW Washington Square Rc'
\ sign The Paper Station
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PERMIT NO. �/� FINK TNnporary F'I•
A PLICATION FOR BUILDING PERMITGRE EN Circulation
WA SHING ION COUNTY BUILDING
ADDRESS
DEPARTMENT OF PLANNING
BUIL DING DIVISION LOCALITY
INSPECTIONS 648.8761 IAF TER 4 30 640-35611 NEAREST
CROSS ST
CENSUS l IOROUP (TYPE ZONE
FOR APPLICANT TO FILL IN TR. CONST _
SUILOpINO MIN/SETBACK f F S RADOEI!SS/QJ4lD 31.1_14).$ . A- 400 -
LEGAL DESCRIPTION APrD.BY `/99?A'TF61151&/- __ _� -
ZONIN; 6/5/&
PLAN f XAMINATION
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AREA OF LOT No OF SLOGS STRUCT.'NOR.
NOW ON LOT
EE0111rvO BLDG.
TYPE OF SANITATION
OWN' TE I. DRIVEWAY PMI
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ADDRESS SSI 4;.a y1- fh -- -
CITY
CCU,.1 COMMENTS •
or NGINEOR Z NOI • �P /I. 1 }� � /�
ADDRESS - - -- - -rr,_ " -IL' L .'W _.. _
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DESCRIPTION OF WORK
NEN ADD .LIEF( REPAIR DEMOLISH
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312E T --� MORRIS iIIOLIES
NO.SIOROOMS NO.OP BATHROOMS
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USE OF Ot�O! c]datt
VALUATION$ L,'7�r/ .00 PSI PON IAMOUNT RECEIPT NO. DATE
V.0 { FES S/ EE S X ZONING COMPLIANCE
IT
HERESY ACKNOWLEDGE THAT I HAVE 7l)'
EAD THIS FIRE MARSHAL
APPLICATION AND STATE THAT THE ABOVE IS COh
RECT AND AGRLE TO COMPLY WITH ALL COUNTY OR -�
DINANC[S AND STATE LAWS REGULATING BUILDING SYSTEM OEVILOPM'NT
CONSTnUCTIO, NO LICE INC;
SIONATUR' •F 7 ---- / ~ X407 jg-
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PLMN CHECK VALIDATION CK M.O CASH PERMIT ALIDATION CK M O CASH
RICEIPT NO DATE RECEIPT NO DATE
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