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3-129 Oc eccA. 61 Q cl,
Report of Special Inspection
Permit Number
Inspection Type(s)
Inspection Date(s)
inspection Made, including
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List Tests Made; jzjISC/A(—
Total Inspection ]itnc Eaeti
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] Periodic C -><'] Continuous
c"tst lterns Requiring Correctior., include uncorrected items previously listed
1
" ` �"L of my knowledge, the work inspected was in accordance with the Building Department
Excepted design drawin
except as d
gs, spr' !cations and applicable workmanship provisions or tie U.B.C.
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Signed: Date — �i/9��0
A1,
Registration No. - / /OS
FORM S I-02, 90
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