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20120327 Permit Pkt 12112012 City of Yelm Permit ►vo.: 20120327 � Community Developme�t Department Issue Date: 12/11/2012 (Work must be completed within 180 days) Building Division Phone: (360)458-8407 Fax: (360)458-3144 Applicant: Name: EVERGREEN STATE BUILDERS Phone: 253-475-6622 Address: P.O. BOX 39753 LAKEWOOD WA 98499 Property Information: Site Address: 10005 JENSEN DR SE 33 Owner: EVERGREEN STATE BUILDERS Assessor Parcel No.: 78640103300 Subdivision: TAHOMA TERRA Lot: 33 Contractor Information: Name: EVERGREEN STATE BUILDERS Phone: 253-475-6622 Address: P.O. BOX 39753 LAKEWOOD WA 98496 Contractor License No.: EVERGS6980P6 Expires: 10/02/2006 Project Information: Project: NEW RESIDENTIAL BUILDING Description of Work: LOT 33, PLAN 2844 Sq. Ft. per floor: First 1293 Heat Type(Electric, Gas, Other): GAS Second 1551 Third Garage 767 Basement Fees: Item Contractor Fees NEW RESIDENTIAL BU�LDING EVERGREEN STATE BUILDERS $17,683.01 MECHANICAL NUCCIOS HEATING $ 84.75 PLUMBING TOP NOTCH PLUMBING INC $ 132.00 TOTAL FEES: $17,899.76 Applicant's Affidavit: OFFICIAL USE ONLY I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints: Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants, easements and restrictions of record. If applying as a contractor, I further certify that I am currently Final Inspection: registered in the State of Washington. Signature .��'� Date ��r Date: -� ey. Firm U � � � M ' � � � N N � (a � � � � � � N V Qo N � Q �_ o � Q � V N ,� � � � � $� � � � U O >+ � C� E o � N � q 0 � � � ' Z a� V :�, � � � U � O a � � � �l r� � •� N 4� �' � � � � � � � �3 � mc� y\ C.� � � � O ''� c� �a cv � � a � � rn � � 'N � p� � � �� q � w � � � � �- �- � � M � � � � N �'� � w m � � � � � � � H � � � L � .� � � M Q � Q� � � C�' �J Z �n � � � � 4> w Z � � o � U � � w � >Cp �`. � Z �� p � M � � � �n c� �n � m W ° ,a. u1 � � � ° W � Y � N O � � ° W � g N Z � � � a� � ¢ c� � � � M �, ~ � z �— _ � � �, � � o . . a� �. � '�� a � � � � J U � �U N � � � Q � � � � � Q x Z Q � � V � � L L � L � � � C C � � f�4 � � �d m � � m � Q (/) m Cit� af Y�lm f36 ) 458-84Q2 ��C#: 130113i112 12/11/2012 1Qn2`� AM OPER: C[� T'l-:�iM: QO1 REF#: 328H3 �(�HAN: :i3.(1000 BUILD.CNG pERM1��TS 2U 12.U;327 1 i',899.7fiGR �U��kGF�EEN S�I�TE� 6UILDEF�S 10005 JENSEN DR 5E 33 SLD-RkSI 11,683.U1Ck MECH 8�.75CR PL 132.Of)(:R �fRAN: 353,OOU�J BUTI.DING F'EF�M.I�IS 201103:'18 17,�U9.(�OLR EVERGF�EEN �TATE BUII_DEI�S 9963 JEN;aEN DR SE 3(7 ��a�� 17,692,25CR MEC;H g4,�5CR �'L 132,�)OCR ff�AN; 33.(�(7UU BUILDING F�ERM:iTS 2U12f�33U 18,232.40CR EVEf�GREEN SrATE Bl1ILUE:�iS �975 JENSEN DR SE 32 BLD-RES1 18,(�15.65CR MECH 84�75C� �'�- 1:�2.OQCR �ikNI�ERED: 54,U41.16 CHE(,K APPLIED: S�,Oq1.1G- _..__.__._...__.___._,_ CHANGF�: U,�(� YELM COMMUNITY SCHOOLS PO BOX 476 YELM WA 98597 Clerk: Croy Terminal: 1 Recei pt: 196948(Reprint} Manual Receipt: EVERGREEN 2534756622 EUERGREEN STATE, BUILDERS LLC � 12/12J2d12 11 :06 AM Q�_Item_�� _ Price 1 CPF MITIGATION 3015,00 MITIGATION 05-027 / LOT 30 / TAHOMA TERRA 1 CPF MITIGATION 3015,00 MITIGATION Q5-027 / LOT 31 / TAHOMA TERRA 1 CPF MITIGATION 3015.00 MITIGATION 05-027 / LOT 32 / TAHOMA TERRA 1 CPF MITIGATION 3015.00 MITIGATION �5-027 / LOT 33 / TAHOM� TERRA 5ubtotal : 12060,00 Tax: 0.00 Total : 12060.00 Check 12060.00 32922 Change Due: 0.00 REPRINT RECEIPT THANK YQU � - 2.��2�3a�7 CITY OF YELM RESIDENTtAL BUILDING PERMIT APPLICATION FORM Project Address: I 00 0 ,� �@�,5ut j)f: S� Parcel#: 78� `+'�� o?3 o O Subdivision��tn.�t--T�«- Lot#: 3 3 Plan#: gy Zoning: �New Construction i ! Re-Model/Re-Roof/Addition � � Home Occupation Sign ' Plumbing Mechanical Mobile/Manufactured Home Placement ' Other Project Description/Scope of Work:�nif'� ��S ��'1'' ��''c`�'O� Project value: 2.7SF 6o a �3� J�O. ^ Building Area(sq. ft) 1S' Floor�2�3 2nd Floor�SS� Garage 7b7 Deck , v�y�e�,� �� Basement Carport Patio�rs"L" #Bedrooms #Bathrooms?l2 Heating:�OTHER or ELECTRIC(Circle One) Are there any environmentally sensitive areas located on the parcel? �0 lf yes, a completed environmental checklist must accompany permit application. BUILDING OWNER NAME: ✓Pj r�¢H v�l �l ADDRESS P D• � 34'7,1'8 EMAIL e -e�`9'� " Y��°?• CITY 4+e kt wd•d STATE �'� ZIP Y�Y!� TELEPHONE ,ZJ"3 - Y7J=66 t 2_ ARCHITECT/ENGINEER�(av-k �+�,y�rs LICENSE# � 7y ADDRESS�2d6 Sd'fi'dt•cF,a1MN 5K 2�0-8 EMAIL�`t e.t �tis.oi- C.� es��/.KGf" CITY6� 1'F•� s� STATE b✓•t ZIP 'P833S" TELEPHO� PS�'� 32�f8 GENERAL CONTRACTOR�t/�r�w.w t�R�:Lcu.r3 TELEPHONE 2s? -��1=6bLZ- ADDRESS T�o. $a`F 3!t,t3 __EMAIL ��e ew�*�j+�eMt�Dv:tc�n •� CITY Lrkewa+7C STATE ZIP QPYY6 FqX yd"3-Vt 6�c, CONTRACTOR'S LICENSE#�✓rlCbsPs�t�o�f EXP DAT ITY LICENSE# 2�ov/o Z-o PLUMBING CONTRACTOR lo� �l•��k TELEPHONE 3`a"�f�!6^0803 ADDRESS 1p o• �oX yy! EMAIL Sc,o�Fssr�►�.Q �'��:t -aw-. CITY R��h�� STATE ZIP 9�576 FAX 3 b- yrb-o a'L CONTRACTOR'S LICENSE#7ePn�oPr4B8 D1�EXP DAT CITY LICENSE# (2-"Oo1,Qy�j, o MECHANICAL CONT�ACTOR N�cc i`o� �Fw.�-r�� TELEPHONE 2r3-3•I�' �° ADDRESS7d�N �}" �}✓E Ta�er++,v�A 9PYob EMAIL�3Hsrley� �oN+c�.ff . qp,'}- CITY 7�-c.e N.�- STATE w�i ZI P �8ye FAX 2S3 S�7 �F'Z� CONTRACTOR'S LICENSE#NKu(�f�4SL�b EXP DAT ITY LICENSE#12-� d�Z� � q. a Copy of mitigation agreement with Yelm Community Schools, if applicable. I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above described property will be in accordance with the laws,rules and regulations of the State of Washington and the City of Yelm. �� `� Appl nt's Signature Date Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.) "� All p@Pmits arP nnn_trar+�#erable and will expire if work authorized by such permit is not begun �ce, or if work is suspended or abandoned for a period of 180 c+ays--, �-��-�-A�- •°��-'�' / �f,: ,, ,,�u�, �J � 1 '/; - -- /��" �1 �; ;n;, '! .1 V I . i� f,° f;�I; . . - - t..s.i i.. r,:i ��. I�y.�,\ — , j / ._.,.._ � (360)458-3835 �j 1;____- -- �; .. (360)458-3144 FAX �� EVERGREEN STATE BUILDERS TAHOMA TERRA ', 10005 JENSEN DRIVE SOUTH EAST YELM , WA 98597 PARCEL NUMBER: 78640103300 _ _ 65.14' —.I 5� _--_-- ' ` � —a. -- + �.. .52' -�__..--- -� � i r �, � N 4'x10' PATIO Zs� BSBL DRY WEIL tJ. � �' `-- -�_�~_ -- --- -- � 1 `r O �I-�� J�+� _ � mE PIAN 2844/3 � � t�f� r— �i ��PLAN #Z�� '�� C,D'� ; (G A R AGE R1GHT} d'�r d t ) I� j r� � !� 1 i i �� — — ...1-= � �., 72"x99" I_' ` - YEIM 57�P t_ ��' DRIVEWAY � � i T � 7ANK: L O� � �1 � rn � � � � � f � M t ` _ L ` i5' BSBL � I -� r / '� -- —.� J �+Mj TRANSFORM "' ' �l � �'�0' UlJll EASEM�NT � v � �� c� _i � �� ' P iMG 6a.�� ----.._ _-- CARSON /� s+DE�1'A�K BOX•—� , ' 4'--- WATER VESUVIUS ' µ �ME7ER ��-��,�4�� PtuM raE� JENSEN DR S � �� " — — � �«a��-,�� _�_zz�_._..� �rz� ,,� ;� � � �� NOi�tN cQ2Gi0 Sher!?es�cn 25.'�5'�I 1591 EU085121�,t�eet f'a�kf�nd,WA9�3�t44 �C�� ,, = 3m, DRAUTYi DATE:f�VIS!Cit Dd1E I�N6:CN DASE l2Ev16�C7V DA1E YEYtS�DAIE f�Y5i0ti DAtE REY51py D47L R71T: PFOJECS': b•M•101d 19•I5�70U 64-Y4-2o11 {9�26-70�3 II-9•$DI2 p-S-t017 1L4.7017 JLS E58-7ANQ1A TERRA Myers Engineering , LLC 3206 50t" Street Ct NW, Suite 210-B Gig Harbor, WA 98335 Phone: 253-858-3248 Email: myenqineerCa�centur tey I.net October 26, 2012 Attn: Building Department Ref: Plan 2844/3A Site Location: Lot 33 at Tahoma Terra (9969 Jensen Dr SE—Yelm, WA) This is a Site Specific Enqineering Letter for the above referenced plan to be built at the above referenced location. The plan referenced above and described in the accompanying construction documents and calculations, was designed for compliance with the requirements of the 2009 IBC/IRC for the design loads expected at the above referenced site. If you have any questions, please give me a call. Sincerely, `��.R• �, Mark Myers, P.E. ��,�& � Project Engineer �� r�i o � ` ,p a��2 ��n� �' , '?.� ,°`�.'��,A��,�, w f 1 :�� ;�r"� - �d � FIL� , ._ _..r_, _ _ : .� Page 1 of 1 � "'�° �'�-=� � � � � � _.� .> _� � _� __ � �_ ,,, .: ;:________________ L evel Design, LL C 611 S Yakima Ave Tacoma, WA 98405 253.284.3170 Fax 253.284.3183 i November 8, 2012 Attention: City of Yelm Building Department Building Location: Lot 33 in Tacoma Terra 10005 Jensen Drive SE, Yelm, WA 98597 Evergreen State Builders is authorized to construct our plan 2844/3 for a single use on the site address referenced above. Any revisions or alterations must be authorized by Level Design LLC prior to commencing work. Sincerely, �J�� John Kilbourne President Level Design LLC 253 284.3170 253 284.3183 (Fax) � �� L �: R.- _, .��,�� _,�._r f� ��, �� rv� � � �� {(i �e.; k t � , a:?J;.'.� B�°:-------------------- Prescriptive Energy Code Compliance for Single Family and Duplex Housing: Zone 1 Project Information Contact Information � - Tahoma Terra Lot 33 Jeff Kelle 253-255-1616 10005 Jensen St. SE Ever reen State Builders LLC Yelm, WA 98597 6020 Main St SW ste H, Lakewood, WA 98499 This set of forms has been developed to assist permit applicants documenting compliance with the Washington State Energy Code, (2009 edition). This set is for structures built under the IRC and located in Climate Zone 1. The following forms provide much of the required documentation for p�an review. The detaifs noted here must also be shown on the drawings (WSEC 104.2). This form is not a substitute for the energy code itself. To obtain a copy of the energy code, go to the following web address. http://www.energy.wsu.edu/code Glazing Wall'� Wall� int4 Wall� ext� Slab� io Glazing U-Factor poor' , VaulCed 5 Option Area . Ceiling , Above Below Below Floor on o i i U-Factor Ceiling' Grade Grade Grade Grade /o of Floor Vertical Overhead R-49 or R-21 R-21 R-10 � I 13% 0.34 0.50 0.20 R-38 R-�8 �nt� �,B R-10 R-30 �, Adv. R-49 or �_�� R_�� R-10 R-l0 R-30 (�� II 25°/a 0.32 0.50 0.20 R-38 R-38 �nt, TB �, Adv. R-49 or R_2� R_2� R-10 (� III Unlimited 0.30 0.50 0.20 R-38 R-38 � ,j,B R-10 R-30 �, Int. Adv. See WSEC table 6-1 for footnotes Glazing Schedule Attached to Document Does not apply. (SEE INSTRUCTIONS) Using Prescriptive Option III. All glazing ' � ' and doors meet maximum U-factor. Alternate heating size method submitted. [� Option I or II, Glazing to floor area limit (WSEC 602.7.2} ' �', Area weighted window, sl<ylight or door U-factor (WSEC 602.7.2) U As part of the heating system sizing calculation (IRC M1401.3 &WSEC 503.2.2) Radiant slab: [—) R-10 foam insulation, continuous with thermal break (WSEC 502.1.4.9) Chapter 9 Options Total of 1 Credit Required Opt. Opt. Description 1 a High Efficiency HVAC Equipment 1 1.0 ;�] 1 b Hi h Efficienc HVAC Equipment 2 �- 1c High Efficiency HVAC Equipment 3 � - 2 High Efficiency HVAC Distribution System ' r. 3a Efficient Buildin Envelope 1 . _ 3b Efficient Buildin Envelope 2 - 3c Super-Efficient Buildin Envelope 3 4a Air Leaka e Control and Efficient Ventilation ,' 4b Additional Air Leaka e Control and Efficient Ventilation � 5a Efficient Water Heatin � 5b Hi h Effiecienc Water Heating - 6 Small Dwellin Unit L— ; 7 Lar e Dwelling Unit 8 Renewable Electric Ener *1200 kwh � Total Credits 1.00 WSEC Prescriptive Worksheet(2010 edition)Zone 1 WSUEEP10-010 Copyright 2010 Simple Heating System Size: Climate Zone 1 Project Information Contact Information • Tahoma Terra Lot 33 Jeff Kelley 253-255-1616 10005 Jensen St. SE Ever reen State Builders LLC Yelm, WA 98597 6020 Main St SW ste H, Lakewood, WA 98499 Indoor Design Temperature 70 Outdoor Design Temperature 17 Design Temperature Difference (oT) 4T= Indoor-Outdoor Design Temp 53 Conditioned Floor Area 2844 Conditioned Volume 20045 Glazing Copy Sum of UA from Glazing Schedule 163 Attic U-Factor X Area = UA R-49 0.027 1551 41.9 R-38 Advanced 0.026 Single Rafter or Joist Vaulted Ceilings U-Factor X Area = UA R-38 Vented 0.027 � � Above Grade Walls U-Factor X Area = UA R-21 0.056 2769.5 155.1 Floors U-Factor X Area = UA R-30 0.029 1293 37.5 Below Grade Walls U-Factor X Area = UA 2' Depth Walls 0.042 3.5' Depth Walls 0.041 7' Depth Walls 0.037 Slab Below Grade F-Factor X Len th = UA 2' Depth 0.59 3.5' Depth 0.64 7' Depth 0.57 Slab on Grade F-Factor X Len th = UA R-10 2' perimeter 0.54 R-10 Full - Heated 0.55 Sum of UA 39� Envelope Heat Load 21056 Btu / Hour Sum of UA X�T Air Leakage Heat Load 11474 Btu / Hour ((Volume X 0.6)X 4T)X.018)) Building Design Heat Load 32530 Btu / Hour Air Leakage+ Envelope Heat Loss Building and Duct Heat Load �1 32530 Btu / Hour If ducts are located in unconditioned space: Sum of Building Heat Loss X 1.15 If ducts are located in conditioned space:Sum of Building Heat Loss X 1 Maximum Heat Equipment Output 150% 48795 Btu / Hour Building and Duct Heat Loss X 1.50 WSEC Prescriptive Worksheet(2010 Edition) WSUEEPIO-010 Copyright 2010 Gl,azin� Schedule Project/nformation Contact Information Tahoma Terra Lot 33 Jeff Kelie 253-255-1616 10005 Jensen St. SE Ever reen State Builders LLC Yelm, WA 98597 6020 Main St SW ste H, Lakewood, WA 98499 Conditioned Floor Area 2844 Sum of UA for Heating System Sizing 114.7 Sum of All Glazing Areas From Below 376 Glazing to Floor Area Ratio 13.20% 602.7.2 Exception Ratio (not to exceed 1%)� Exterior poors Plan Component Door Percent Width Height Glazing Door poor ID Description Ref. U-factor Glazed Qt. Feet Inch Feet ��°n Area Area UA 1 3 6 8 20.0 One Exempt Swinging Door<24 Square Feet Sum of Glazing Area, Door Area, and UA (do not include exempt door) 20.0 Area Weighted U = UA/,4rea Sum of Area and UA for Heating system size only (include exempt door) 20.0 Vertical Glazing (Windows, Glazed doors using Exception 602.6 #1) Plan Component Glazing Width Height Glazing ID Description Ref. U-factor Qt. Feet Inch Feet ��°h Area UA 0.290 3 2 6 6 45.0 13.05 0.310 6 5 4 120.0 37.20 0.300 1 6 8 48.0 14.40 0.310 1 5 5 25.0 7.75 0.310 2 2 6 5 25.0 7.75 0.310 2 5 6 60.0 18.60 0.290 2 1 7 14.0 4.06 0.310 1 5 4 6 22.5 6.98 0.310 1 4 4 16.0 4.96 Sum of Area and UA 375.5 114.75 Area Weighfed U = UA/Area 0.31 WSEC Prescriptive Worksheet(2010 Edition) WSUEEP10-010 Copyright 2010 Overhead Glazing Plan Component Glazing Width Height � 'ID Description Ref. U Qt. Feet Inch Feet �n°n Area UA Sum of Area and UA Area Weighted U = UA/Area Doube Glazed Garden Windows Section 602.7.2 Exception Plan Component Width Height ID Description Qt. Feet ��°n Feet �nch Area UA Sum of Area Sum of Area X 3 (This total is automatically included in the glazing area total.) Glazing UA for Heating System Size Only =Area X 0.63 WSEC Prescriptive Worksheet(2010 Edition) WSUEEPIO-010 Copyright 2010 �.�� - `2o I �o�2 �7 � � TION � INSULA � ��o Q��. NORTH �/V� EST �,�Hj,�' Insulation Certificate/Blower poor Test Form Batts&Blankets Thermal Performance(Attic Application) When installed in accordance with the manufacturer's The stated thermal resistance(R-value)is provided by installing in accordance with the manufacturer's recommendations,Knauf Batts&blankets will provide instructions,the required number of bags per 1,000 sq.ft.of net area,at not less than the labeled minimum the full R-value. thickness.Failure to install.both the required number of bags&at least the minimum thickness will result in lower insulation R-value. To obtaiii an 'Tnstaitec�in3ulation To o6tain an 'Fhe num6er of 'Contents of flus.6ag� The WeigtiUSF of ` InstalleG insulatioa ` insulation resistmtce sfiould not tie less insulation bags/1,OOQ SF of ne shouid not cover more instatled insulation should nofi be]ess R-Value o�` than: resistance area should not be than: should not be le§s than: than: -Value of: R-38 HD 10.25" R-60 29.7 33.6 SF .9521bs. 19.750" R-38 12.00" R-49 23.5 42.5 SF .7531bs. 16.375" R-30�3B 3.25" R-44 209 47.8 SF .6701bs. :4.375" R-30 10.00" R-38 17.8 56.2 SF .5691bs 13.000" R26 9.00" R-30 13.6 733 SF .4371bs 10375" R-22 6.50" R-26 11.8 85.0 SF .3771bs 9.125" R-21 HD 5.50" R-22 9.8 102.2 SF 313 Ibs 7.750" R-19 6.25"'�"� R-19 8.4 1193 SF .2681bs 6.750" R-15 HD 3.50" R-13 5.7 175.3 SF .1831bs 4.750" R-13 3.50" R-11 4.7 210.8 SF .1521bs 4.000" R-11 3.50" Bag Weight-Nominal 301bs,Minimum 291bs.This product conforms to the performance requirements ofASTM C 764, R-8 2.50" Type 1,&cancelled Federal Specification HH-1-1030B,Type 1,Blass B.R-Values are determined in accordance with **R-18 in a 5.5"cavity,Conforms to ASTM C 687&C 518."R"means resistance to heat flow.The higher the R-value,the greater the insulation power.To get the C665&Federal Specification HH-1-521F inarked R-value,it is essential that the insulation be installed properly.If you do it yourself,get instructions&follow them. To achieve labeled R-value,this product must be applied with a pneumatic blowing machine&a corrugated hose with a minimum.25"internal corrugation,a minimum length of 150 ft.&a diameter of at least 3".Coils in the hose should not be less than 36"in diameter.Acceptable material feed rate is 5-35 Ibs./minute.Recommended feed rate is 15-251bs./minutes. Builders Insulation Statement. Batts and/or blankets ha�e been installed in conformance with the above 2009 WSEC Residential Enerev Compliance Certificate-Buildins Air Leakaee recommendations to rovide athermal resistance o£... R-Value Standazd Buildin &Test Condition: Comments: Attic Area R- q R-49 Date: 4 4 ('S Ext,Walls R- Z R-21 Time S'3� Inter.Walls R- R-11 Indoor Temp: S rinkler Tenting R- R-8 Outdoor Tem : S Knee Walls R- R-21KF Floor Area(sq ft) �{ Completed as of. Buildins Air Leakaee Target: SLA Less Than 0.00030 Installers Name Print: �� Test#1-Depress�Press Pretest Baseline Pressure (Pa) Installers Name Sign: M��`-� Sld Press. a Flow R' Fan Press. a Flow cfm , + _ ZO SiteAddress: 1A005 $�SGK S'� SE WIgD �'� Post Test Pressure: Fan ModellSN: �� Results:SLA(Specific Leakage Area): . �OO ZZ Home Builders Signature: Test#2-Depress Press Pretest Baseline Pressure (Pa) Home Builders Address: Bld Press. a Flow Rin Fan Ress. a Flow cfrn Insulation Contractor: Insulation Northwest LLC Post Test Pressure: Fan ModellSN: P.253-846-0121 P.O.Box 732069 Resuits:SLA(Specific Leakage Area): F.253-846-8096 Puvallup,WA.98373 Affida�it: I certify that this Specific Leakage Area is accurate&determined using Blower poor Test Standard 502.4.5 Building Air Leakage Testing. Technician Name Print: Technician Name Sign: �� s�� °� e� g '� ��, �� ;��a��a � .; ca � ��"� ��?s��a��+��& s � �� s �� } � / � � �� '�� --G�/ �� , �� '��a ��'�� , s �� l)UCti.fi.�IkA�E,lffi;daYit � " � ��, �� s � k �� B� � � � � � � �� a�. P@t711tt�: ��..J� � �� : i"�u h% �a�� u � A�, � 3 ��` � �� t �� e,�ST�, � �� i � '��a � ��a°^ . ' �� . ; � s �, �i'��-s a *�a� �'� House addr�ss or iot n�rmb�r ��i ��,�� g ,'� �� s�� a � �� ` � � a � � � �� ,� � �E �: � � ��a,� a � � � s ��r�� a�� , ��a �'� e r `��r � � z�" � �, �' ��`" ��`` � � � Zip: �� z ��"'" � a s �� ' ,°�'�r�"�� ,�y� ��a ��. & � t e � � � �� a � p z a �"��a�a�°�� . � ,� 3 � Ek �a P � '"Yt'�'$.�a'��,� ��,�.. Cand;Floor Ar�a(ft). 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