HomeMy WebLinkAbout2784 Galicia Way; ; 77-7187; PermitMOD EL NO. _. __:;_/_.:,...:...:n:;_o=--"'-.L.:'C,"'---·
BUILDrNG PERMIT APPLICATION
,c::I -City of CARLSBAD, CALIFORNIA 92008 ., " ~
7
5'"'6* "c-11
--; --7 J ') -,
Applicant to complete numbered spaces only Phone 7 29-1181 Permit No -/
JO"io1".f4 ASSESSOR 'S
,.!_/ ~ PARCEL NUMBER .__ ., _,_._) &• -
LOT NO. l9 "' I TRACT 6vvK 7'J'8'E I PAR.
1 ~~;~~--(nSEE A T TACHED S11EETI 1 Ti ., I l . . , .,
OWN[jq MAIL AOOR[SS ll p PHONE
2 J ----~~3 l. ' 9 7 (.. -v• J • • -. • ... ~ .
CONTRACTOR MAIL AOORCSS PHONE STATE LIC. NO. CITY LIC. NO.
3 ,c.:::.: ~ in Co~. 903 J r:i. • 7S5-1 .. • I .
ARCHIT[(T OR OC51(;N(III MAIL A OORCSS -,:r .. ,n
PHON [ LICENSE NO
4 ... s 75S-3, -':' • , __ ,~ • -,. ,. • • -
tNGINE[R MAIL ADDRESS PHONE LICENSE NO.
5
COMPENSATION INS. CARRIER MAil ADDRESS &,U ,NCH
6
USE OF BUILDING
7 ,.:.;_;_ ,~c. NO. BDRMS 3 NO. BATH' i
8 Class of work: GNEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE I ~r (\
9 Describe work: L.l~\, , \ tYl&A_ l l} N\Ol,,Q ( .1-v\. .......... '> \, / i,~L.i>. rt.. J ~~v~ ..._\, V 1\1 . 1
\I iv ~ ~ y
I I
~ IQ 10 Change of use from
Change of use to
11 Valuation of work: $ J) ,t./1 -I ~, -PLAN CHECK FEE S / PERMIT FEE S
SPECIAL CONDITIONS: MICRO FILM FEE Type of ,J Occupancy
Const Group l"J
Sile of Bldg. No. of I Max.
(T otalJ SQ. Ft. <j I) Stories 0cc. Load
Fire use I Fire Sprinklers -· APPLICATION ACCEPTEO BV PLANS CHECKEO BY APPROVED fOA ISSUANCE ev zone .J Zone Required 0 Yes 0No
No. of OFFSTREET PARKING SPACES:
R· '< Dwelling U nits No. I No. DATE DATE Covered Sq. Ft. I Open
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-PLANNING DEPT.
ING, HEATING, VENTILATING OR AIR CON DITI ONING. HEAL TH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
T ION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF F l RE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGINEERING DEPT. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WATER DEPT.
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES N OT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER S1ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
51CNATURt or CONTAACTOIII OA AUTHOAIZtD ACENT (DATE)
SIGNATU III[ O' OWNER (If' O WN[III 9U ILOEIII) IOAT[)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
., (
TOTAL FEES$~~-=-)_/:.._~,/~--~
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ELECTRICAL PERMIT APPLICATION-:-
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Perm it No '? 7-f y~
JOB ADDRESS
f ~ c:::.!> '· ~ ''
LOT NO. I BLK. I TRACT (QSEE ATTACHED SHEET) LEGAL I C 1 DESCR.
OWNER MAIL ADDRESS ZIP PHONE
2 .,~r...,o, A ~\Z,;4.!
CONTRACTOR MAIL ADDRESS PHONE STATE LIC. NO. CITY LIC. NO.
3 • l '~ .... _ 1· \' 1 ·--~
ARCHITECT OR DES IG HER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
COMPENSATION INS CARRIER MAIL ADDRESS BRANCH
6
USE OF BUILDING
7
8 Class of work: ONEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS: SWI MMING POOL WIRING,
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
Al'l'LICATION ACCEPTED av PLANS CHECKED BY APPROVED FOR ISSUANCE BY AMPERES OF MAIN SERVICE, SWITCH,
/t'V FUSE OR BREAKER 'i/1)1,~ (. .s ,, _.-, .
I DATE NEW SERVICE ON EXISTING BLDG.
FOR EA. AMPERE OF INCREASE NOTICE IN MAIN SERVICE, SWITCH, FUSE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-OR BREAKER
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A REMODEL, ALTERATION, NO CHANGE PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM
MENCED. IN SERVICE, FOR EA. AMPERE OF
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS INCREASE
APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCE!> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO AND INCLUD· PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE ;;$" PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
II .I TEMP. SERVICE OVER 200 AMP.
PER 100
,. 4'. ·" ,z
SIGNATURE OF CON'fRACTOR OR AUTHORIZED AGENT (DATE) ,:;,. ISSUANCE FEE -
TOTAL FEES $,J. SluNATURt OF OWNER CIF OWNER BUILDER) OATF'
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
---. '
PLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 729-1181 Permit No
Joe ADO ft ($S
'~14S. (.!AL,lC.I ~
LOT NO.
LEGAL I 1 D£SC•. 210
I OL K
OWNEfll MA.IL AODJltESS
2 Sc.A~t:)<~ Cu,-z.r=>.
CONTftACTOR MAIL AODR£5S
3
AJltCHITCCT OR O[SIGNE.111 MAIL A.001111[55
4
EN, IN££11t MAIL AODRlSS
5
COMPENSATION (NS. CARRIER MAIL AOOlll.(55
6
USE or BUILDING
7
8 Class of work : CJ-NEW 0 ADDITION 0 ALTERATION
9 Describe work : IQoo rz
SPECIAL CONDITIONS
·'
,,
APPLICATION ACCEPTED av PLANS CHECKED BY APPROVE O FOR ISSUANCE BY
DATE
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO 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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION
.JJ1 J!
I _,, • / l_ /.7/ ( IL •-__ __.
S1 GNATU91tt or CONTR'ACTOIII OR AUTHOAIZED AGENT
S1GNAT11f1S' OP' OWHEJI II" OWNER 9UILOtft) IOATE}
ZIP PMON[
PHON t STATE LIC. NO.
PHONE LICtNSE NO.
PHON[ LICENSE HO,
0 REPAIR
PERMIT FEES
No. Type of Fixture or Item
2. WATER CLOSET (TOILET)
I BATHTUB
1' "'J LAVATORY (WASH BASIN) .... SHOWER
• KITCHEN SINK & OISP
I DISHWASHER
LAUNDRY TRAY
' CLOTHES WASHER
• WATER HEATER
l URINAL
DRINKING FOUNTAIN
FLOOR-SINK OR DRAIN
SLOP SINK
I GASSYSTEMS NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
' SEWER NUMBER CLEANOUTS
t CESSPOOL
SEPTIC TANK&. PIT
ROOF DRAINS
ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
CITY LIC. NO.
Fee
$ .> I'. l)
/ ~ ,")
.,/ ( ,....,
I / )
I V
:, C
/ . ::)
I ":.v
$
$
CASH
MECHANICAL PERMIT APPLICATION :;
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. Phone 7 29-1181 Permit No
L. ' ~ ·-4 <.::i
LOT NO.
LECAL I 1 OUCR, ..::..10
I BLK I TRACT
OWNC .. f' 2 :Sc~,..,,o, ~~-· MAIL. AODl'IESS
CON Tll':AC TO"' MAIL ADDRESS
3 ,,Q"' 1-,,~
Ai.CHITECT 01'1 DESIC.NC" MAIL A00"ESS
4
ENGINEEl'I
5
L[NOUI
6
USE 0,. I UILOINC
7
8 Class of work: ONEW 0 ADDITION 0 ALTERATION
9 Describe work :
SPECIAL CONDITIONS.
~ -(/ -
APPLICATION ACCEPTED IIY PLANS CHECKED BY
J~ I)
NOTICE
'
/V//J /.,.
APPROVED FOR ISSUANCE BY
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO 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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
I ~ -
SIGNATUl'lt Or CONTllf:CTOfll Otlt AUTHOIIIZ.l:D AGENT • (DATE)
~l~NATUfl .. OP' OWNElll ,,. ow,u:lll autLO[fl OAT£
tOscc ATTACMCD SHE.CTI
ZIP PHONE
PHON C STATE LIC, NO,
PHONE LICENSE NO.
PHONE LICENSE NO.
Bl'IANCH
0 REPAIR
Type of Fuel: Oil 0 Nat. Gas D LPG. D
PERMIT FEES
No. Type of Equipment
Air Cond. Units-H.P. Ea
16 Refrigeration Units-H.P. Ea.
Boilers-H.P. Ea.
Gas Fired A.C. Units-Tonnage Ea.
I Forced Air Systems-8.T.U. M Ea.
Gravity Systems-8.T.U. M Ea.
Floor Furnaces B.T.U. M
Wall Heater~-8.T.U. M
Unit Heaters B.T.U. M
Evaporative Coolers
, Clothes Dryers
r Ventilation Fan
,/ Range Hood
Air Handling Unit-C.F.M.
Incinerator
ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
.. "
CITY LIC, NO.
Fee
$
4. -
z. -
z. -
2. -
CASH
1 ,J) ~/ (
~
,1
i ' -INSULATION CERTIFICATION ... •
This is to certify that insulation has been installed in conformance
with the current energy regulations, California Administrative Code,
Title 25, State of California, in the building
SITE ADDREss,,<,,z ,t-~'7() -/M 6a /,·c. -·c,, / k@.?2;,, { 7 ,
EXTERIOR WALLS ~
Man u fact u re r{.)(,<1~£ (jzvz,,,. 1 CEILINGS /fJ
Manufacture~6H,£~~~
Manufacturer / Blown: -~-------
efz t, Thickness/Type I J,-
/ {(
Thickness/Type U --~-----
Thickness/Type _______ _
Wt./Bag ______ _ Sq. Ft. Covered ___________ _
FLOORS
Manufacturer ----~-------Thickness/Type _______ _
SLAB ON GRADE
Manufacturer ------------Thickness/Type _______ _
Width of Insulation Inches -------
FOUNDATION WALLS
Manufacturer ------------Thickness/Type. _______ _
R-Value /('
R-Value /,?
R-Value ---
R-Value __ _
R-Value __ _
R-Value ---
R-Value ---
GENERAL CONTRACTOR LICENSE# ______ _
BY TITLE DA-TE -----
::~ LICENSE# 325251 C2
DATE 711eJ&1 TITLE~.,E,~~c....~-
..
-LOT ;) 70
;}74£
BUILDHlG
FOOTINGS
FOUNDAT I ON
REINFORCED
MASONRY
GUNITE OR GROUT
SHEATHING ujto/zz ttl!
FR.n_ME
INSULATION
EXTERIOR LATH
INTERIOR LATH & DRYWALL
UNDERGROUND 'f .. f' ~
TOP OUT
TU B AND SHOWER
GAS TEST
ELECTRICAL
UND ERGROUND ~-C},... n ~
ROUGH
CEILING HEAT
BONDING
MECHANICAL
DUCT & PLEM , REF . PIPING
HEAT--AIR
VENTILATING SYSTEMS
FINAL:
MODEL NO, _________ _
BUILD NG PERMIT APPLIC TION
City of CARLSBAD, CALIFORNIA 92008 " _--, ""7 -/J ~~ P --1 Y.-:i 1;/r
Applicant to complete numbered spaces only Phone 7 29-1181 Permit No
Joe AODA £~S " ASSESSOR'S
• ~ (-:,t\L.tt\l y PARCEL NUMBER
LOT NO. I BLK I TRACT
BOOK PAGE I PAR,
L[ CAL I ~<IU 7 4-1D•tc ATTAC><to s><ttTJ I DESC~. L fC;.:. .-,.r f\
OWNER :, MAIL ADDRESS ZIP F>MONE -.... ,
2 VP\ l ,AL. '~ c... -"'"-t.:::!" .,
CON Tl'U,C TOA -MAIL AOOAESS
\\\ \ .. ,ol'..
PHON £ $TATE LIC. NO. CITY LIC. NO.
3 ' \ \ -'\/ '-t,.,\ ·A .., ""~ -ARCHI TECT OR OtSIGN[llli MAIL AOOAESS PHONE LICENSE NO.
4
t.NGINEEA MAIL AOO~[SS PHONE LICENSE NO.
5
COMPENSATION INS, CARRIER MAIL AOOlllESS 8AANCH
6
-
USE OF BVILOING
7 ..,
NO. BORMS NO. BATHS
8 Class of work:~ 0 ADDITION DA~ OREPAIR O MOVE 0 REMOVE
9 Describe {ark: ,I
\~ .. o L -4 i~/J __) ...
'--:::
10 Change of use from
Change of use to
11 Valuation of work: $ Ct J ll /, tu :J £> ,-I PERMIT FEE $ ' I ~ (1) PLAN CHECK FEES I
SPECIAL CONDITIONS: MICRO FILM FEE Type Of Occupancy
Const. Group
s,ze of Bldg. No. of Max.
(Total) Sq. Ft Stories 0cc. Load
Fire use Fire Sprinklers
APPLICATION ACCEPTED 8 V PLANS CHECKED ev APPROVED FOR ISSUANCE ev Zone Zone Required 0Yes DNo
' I I No of OFFSTREET PARKING SPACES,
I • I' JNo . /•I CATE /'J/ Dwell,ng Units No. CATE 'I .r Covered Sq. Ft. Open
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB· PLANNING DEPT.
ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FIRE DEPT
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGINEERING DEPT APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS WATER DEPT.
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR THE GRANTING OF A PERMIT DOES NOT NOT, PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE·OR LOCAL LAW REGULATING
CONSTRUCTION OR 'THE PERFO~MANCE OF CONSTRUCTION.
T " I ~ ,
.SIGNATUIII[ 0,. CONTR:ACTOR: OR: AVTHOlll:IZlD AC.!.NT IDATEI .
SIGNAT1Jfll' 0,. 0WN£fll If' OWNCII IUIL.O!R:) 1DAT(}
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION CK. M.O. CASH
-
f.r (. • C -·t., TOTAL FEES$ ________ _
INSPECTOR
INSPECTION RECORD
FOUNDATIONS:
SETBACK ~--~~_,,,~~~~---l~~~~~~~~~~~~~~~~t--~~-
TRE
REI
FOl
WEJ
CONCRE"
FRAM INC
INT. LAl
EXT. LA'
MASO NF
FINAL
USE SPAC
<ttitp of <ttarl.u&ab
REQUEST FOR INSPECTION RECORD
TIME: ____ _
INSPECTOR~,b1t, .: ... I'\ PERMIT NO. _________ DATE: ll:•1JJ ez--
OWNER ___ ---=---rT-----------------------------~
ADDRESS ~~lf ~tnAL-1~
REQUESTEDBY PHONENO. -------------
BUILDING
FOUNDATION
REINFORCING STEEL
MASONRY
GROUT -GUNITE
FLOOR AND CEILING SUB FRAME
n SHEATHING O ROOF D SHEAR
n FRAME
EXTERIOR LATH K')\(_
[J INSULATION V 112.
INTERIOR LATH OR DRYWALL ty •
FINAL
PLUM BING
1 UNDERGROUND PLUMBING
U SEWER AND PUCO
l l TOP OUT PLUMBING
[ TUB OR SHOWER PAN
GAS TEST
WATER HEATER
kLARWATER
/' ,NAL
PERSON TAKING REPORT ____ _
ELECTRICAL
[ TEMPORARY SERVICE
l UFFER GROUND
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
POOL BONDING
-) ELECTRIC SERVICE
/ FINAL
MISCELLANEOUS
CONDITIONED AIR SYSTEMS
SOLAR HEAT
P TIO
OOL
GN
LJ GRADING
DRIVEWAY
[ FINAL
SPA
SPECIAL INSTRUCTIONS ___________________________ _
----------------------------------~
Ready For Inspection: D Monday
~ A.M. D P.M.
D Tuesday D Wednesday n Thursday 0 Friday
J. INTERDEPARTMENTAL INFORMATION SHEET
..
BUILDING DEPARTMENT
BUILDING ADDRESS:
OF CARLSBAD
Building Department
PLANNING DEPARTMENT
UNITS ALLOWED~~~~-------UNITS PROVIDED ____________ _
PARKING SPACES REQUIRED __________ PROVIDED __________ _
PROVIDED -------------% COVERAGE ALLOWED
BUILDING HEIGHT ALLOWED __________ PROVIDED
FRONT SETBACK:
ALLOWED
PROVIDED -------
'_INTRUSIONS
SIDE SETBACK:
LANDSCAPE & IRRIGATION PLAN COMMENTS:
REAR SETBACK:
ENVIRONMENTAL PROTECTION REQ:
ADDITIONAL COMM~TS•~~~~~~~~7J~~~~~~~~~~~~~~~~~~
OK TO ISSUE: tw DATE /dpi(zf OK TO FINAL _______ DATE ____ _
ENGINEERING DEPARTMENT
R.O.W. ______ INDUSTRIAL WASTE _______ IMPROVEMENTS _______ _
SEWER CONNECTION DRIVEWAY LOC~IONS
GRADING PERMIT ~------EASEMENT~({t~ DRAINAGE ____ _
LEGAL DESCRIPTION--1o:.:...=.:::_~-==="'"------------------------
ADDITIONAL
FIRE DEPARTMENT
SPRn;KLING SYSTEM FIRE PROTECTION EQUIP ·--------
FIRE ALARMS EXITS _______________ _
FIRE HYDRANTS __________ LOCATION _________________ _
ADDITIONAL COMMENTS
OK TO ISSUE:
WATER DEPARTMENT
REQUI,EMENTS OF APPROPRIATE DISTRICTS MET ________ DATE ________ _