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20130171 Permit Pkg 05172013 � City of Yelm Permit No.: 20130171 � Community Development Department Issue Date: 5/17/2013 (Work must be completed within 180 days) Building Division Phone: (360)458-8407 "'" ' " FaX: (360)458-3144 Applicant: Name: PUGET SOUND BUILDERS ASSOC Phone: 253-202-5025 Address: 11012 CANYON ROAD E, STE. 8 PUYALLUP WA 98373 Property Information: Site Address: 14457 99TH AVE SE 171 Owner: PUGET SOUND BUILDERS ASSOC Assessor Parcel No.: 78640117100 Subdivision: TAHOMA TERRA Lot: 171 Contractor Information: Name: PUGET SOUND BUILDERS ASSOC Phone: Address: 11012 CANYON RD E, STE 8 PUYALLUP WA 98373 Contractor License No.: PUGETSB903MH Expires: 7/31/2013 Project Information: Project: NEW RESIDENTIAL BUILDING Description of Work: LOT 171, PLAN 1922 Sq. Ft. per floor: First 814 Heat Type (Electric, Gas, Other): GAS Second 1108 Third Garage 486 Basement Fees: Item Contractor Fees NEW RESIDENTIAL BUILDING PUGET SOUND BUILDERS ASSOC $16,402.99 MECHANICAL KLIEMANN BROS. $ 84.75 PLUMBING RAINIER VIEW ROOTER $ 118.00 TOTAL FEES: $16,605.74 ApplicanYs Affidavit: OFFICIAL USE ONLY I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints: Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants, easements an restrictions of re ord. If applying as a contractor, I further certify that I am currently Final Inspection: registered in State of Was n ton. �/' Date: Signature Date By: Firm Cit� af Y�lm (�� ) 458-84U2 �����; (i���(����O 5 j 17/lU 13 12:G7 f�M Q�EF': GU �f E�M; 00�I RFF#; 31�� f�RANo �3�.t)OOII BU1I�DINu PtRM.I1��S �i���:�o�E�� ��,r�2�,a�c� wut,t:r sou�r� ���r�u���s ��soc i4463 9yTN 4VAY SE 17'�7 BLL)��RES�1 1�,61�7.6�CR MkcN 84.75CR NL 125.00CR I�RAlV: ;�:3.u0UC) BIJI�.t)TNi� PERMIT�s �i11�'�0171 16,605�74CR PlJGk1 SC�UN[1 BUII_GERS A�SCJC 144h7 99fN AVE �F 1l1 BL.I.i-RFS 1 16,4�i2.J9CR MECH 84.75[',R PL 11�.�OCR T�IdUE.RELl; J3,4:�3.18 CHEGK AF'P�..IE[l: 3�,433.18-� __ ____.._._______. i;NAlti'f:�k: O.OQ ,' YELM COMMUNITY SCHOOLS `�� ; LOCAL RECEIPT DATE � . I � ; -�, 20 i?. 5�'$��j Received from' � .(.f. �, ---�:,-_ '�'�'r' t`�c._ � E" �Y � FOR ���y���'� ��,�� � ` � � ! f� �{���- 1 � � �9 t�C.. ( �.-��� �. --? `-�;:� '-`'_[! , ��=' � �'k E>i e� � �-� 1 � � � 1 t} �{ r, —� .:<� .� j�� �' �� �d.' �' �, � '` �'��j 1 d��-z�_ � ' ` �_. ._ . ACCOUNTCODE ,^�� ���-=� DOLLARS� A��M CASN CHECK "'�� � ..-� liL� ` � ��� j.'' `� ;r...'� YELM COM1yUNITY SCHOpLS r'. By �,,J �c�. "��`; ( ` `_� ;'� , --,. �- . �� �io�����( CITY OF YELM v RESIDENTIAL BUILDING PERMIT APPLICATION FORM ProjectAddress: t`���� FIUI���',5��arcel#:_..���� d�I��� Subdivision:�U�►l;;'�Ay T�,tyw Lot#.,�_1__ Plan#:_.,`Ga�"__ Zoning: �tVew Construction � ! Re-Modei/Re-Roof/Addition i ; Home OccupaGon Sign ! Plumbing � Mechanical �� Mobile/Manufactured Home Placement i ! Other Project Description/Scope of Work: ��� � Project Value: o��� �� Building Area(sq.ft) 151 Floor �� 2nd Floor�� Garage � Deck Basement Carport Patio,�� #Bedrooms� #Bathrooms�j� Heating GAS/OTHE or ELECTRIC(Circle One) Are there any environmentally sensitive areas located on the parcel? �_ If yes,a completed environFttental checklist must accompany permit application. BUILDING OWNER NAME: 1,;M ' � ADD SS �Iv i (N , � - � AIL f� z � C�TY STATE,�j(�_ZI� � TELE�HON " 1 - ARCHITECT/ENGINEER UCENSE# ADDRESS EMAIL C�TY STATE ZIP TELEPHONE GENERALCONTRACTOR TELEPHONE . - ADDRESS EMAIL (e � �hay�1,�"� (,q� C�TY STAT ZIP FAX CONTRACTOR'S LICENSE# ' �' 1�EXP DATE'1 ' CITY LICENSE# PLUMBING CONTRACTOR TELEPHONE " ADD SS EMAIL I CITY STATE 1N ZIP "1 FAX CONTRACTO 'S LICENSE# 'yti►' EXP pAT CITY LICENSE# - 7�Q MECHANiCAL CONTRACTOR n ' "- TELEPHONE S3-�i�"�- Q 5'� ADDRESS �11U'� \l�r,� EMAIL C�N Tyi01+a►v STATE�ZIP `.�i—�FAX CONTRACTOR'S LICENSE# �� t?t� EXP DATE1 "CITY LICENSE# - ^ � Copy of mitigation agreement with Yeim Community Schools, if applicable. I hereb certify that the above information is correct and that the construction on,and the occupancy and the use of the abo escribed pro will be in accordance with the laws,rules and regulations of the State of Washingto�and the Ci Yelm. pplic t' Signature Date / Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.) All permits are non-transferable and will expire if work authorized by such permit is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 18 ��� � ��° ���D �J � �. MAR 2 7 2013 105 Yelm Auenue West (360)45&3 ' Yelm,WA 98597 (360)458-3 www.ci.yelm.wa.us �a� �� i PUGET SOUND BUILDERS ASSICIATIC�N, LLC TAHOMA TERRA 14452 99th AVENUE SOUTH EAST YELM,WA 9859? PFiRCEL NUMBER: 7$64011?10 _� _ 40.Q0'_ _ . � ! � � 5� , � , � �_._.__..��9 r--_.,_�._:,.�� 6 ;�n � �.- -,1 I�4'x 10' `�' ` DRY WEi.L � 20' BS9 l�; - Ar - � " """ � �ro��t P�rrh ��undatior�And Ste� Tank i � � � c� l��c.;�t}c�r7 Sfij�l! Se 5tak�d Fc�r Sei Back i � � � � � � �y � Ir�s�ectiorj � (� � �' tn '- rn � � � � �q � Q � St�� Tar�k E_x�cavatir�r, In Vioiatior7 Of ,� � � w .— z „ 1�t�e R�quire�� 5' Minimum S��k Back Tc � C� o�„ � w. � �y —� � �c�y�ar��d�ti��n Sha��E3e �ack Fiiled bVith � � �� 8'-9'�- a.o �� C[�F � ^.�� I COVEREO � y .�"�' Y� (,.� PORCH � � i � �— � ! t'+ ) � � � � � , ! �;� � � � , , _�__ _ _ ,o � � � � � � a � � �„� �J Z��B$B ��v�o J 7�'�VY X �OJ�»L X B�J"»D � � i' b _ _....�� Y�LM ST�P TANK N ( i "'� '"_ ` i 4 -2 ._..� , _� S' �__ ��Y � 10' U7fLITY ASEM � l �� '" �' ����w����--- - _ , � L� 40 PLANTING p ��.�_��XSON WATER i'ULIP �p���,,�� C� ����R 99th AVE SE � �rR�e / �� <n _ _ >� �-- -_..._.,..._.._, 5��� ���� r�o��r� Q?_0!3 ;'r;rG%es�� 25��%1 1571 IGi7�5121,t 5treet p��klad WA 9f� � . _a ,.-�- SCALE l' - 20' � � �^ �, p{ DRNlQYo DATE @UL P�ECT: � ��,J`�7'� Q � �U 1� 4-93.J00 Jt8 1'OUl3A•it�FtA 1EPotd f�i4'' � - •----•�•••-- •�..,..y� ......a� vvn�N�ian�.c iu� d117ljIC I'�111111.,/ QIIU UU�I@X 1'10USI�1g: co�n�e � Project Information Contact Information Plan 1922-2 Puget Sound Builders Association 1922 sf 2 story Yelm WA This set of forms has been developed to assist permit appficants 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 plan review. The details noted here must also be shown on the drawings (WSEC 104.2). This form is not a substitute for the energy eode itself. To obtain a copy of the energy code, go to the following web address. http://www.energy.wsu.edu/code Glazing �z a a Glazing U-Factor poor 9 Z Vaulted Wall Wall• int Wall• ext Option Area10: Ceiling 3 Above Below Below Floors %of Floor Vertical Overheadl l U-Factor Ceiling Grade Grade Grade R-49 or R-21 R-21 OI 13% 0.34 0.50 0.20 R-38 R-38 Int.' TB R-10 R-30 R-49 or R_21 R-21 OOII 25% 0.32 0.50 0.20 R-38 R'38 Int.� T'$ R-10 R-30 O III R-49 or R_21 R-21 Unlimited 0.30 0.50 0.20 R-38 R-38 Int.' TB R-10 R-30 Adv. See WSEC table 6-9 for footnotes Gfazing 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. 0 Option I or II,Glazing to floor area limit(WSEC 602.7.2) ❑ Area weighted window, skylight or door U-factor(WSEC 602.7.2) � 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 1a High Efficiency HVAC Equipment 1 �,p � 1b High Efficiency HVAC Equipment 2 ❑ 1c High Efficiency HVAC Equipment 3 ❑ 2 High Efficiency HVAC Distribution System ❑ 3a Efficient Building Envelope 1 ❑ 3b Efficient Building Envelope 2 ❑ 3c Super-Efficient Building Envelope 3 ❑ 4a Air Leakage Control and Efficient Ventilation ❑ 4b Additional Air Leakage Control and Efficient Ventilation ❑ _ 5a Efficient Water Heating � 5b High Effieciency Water Heating ❑ 6 Small Dwelling Unit � 7 Large Dwelling Unit ❑ 8 Renewable Electric Energy *1200 kwh ❑ Total Credits 1.OU WSEC Prescriptive Worksheet(2010 edition)Zone 1 WSUEEP10-010 Copyright 2010 c�iazmg 5cnedule Project lnformation Contact lnformation Pian 1922-2 Puget Sound Builders Association 1922 sf 2 story Yelm WA Conditioned Floor Area 1922 Sum of UA for Heating System Sizing 119.0 Sum of All Glazing Areas From Below 308 Glazing to Floor Area Ratio 16.01% 602.7.2 Exception Ratio (not to exceed 1°/o)C� Exterior poors Plan Component Door Percent Width Height G(azing Door poor I� Description Ref. U-factor Glazed Qt. Feet �"�n Feet ��0n Area Area UA SLIDER 0.32 1 8 8 64.0 20.5 One Exempt Swinging Door<24 Square Feet Surn of Glazing Area, Door Area, and UA (do not include exempt door) 64.0 20.5 Area Weighted U= UA/Area 0.32 Sum of Area and UA for Heating system size only(include exempt door) 64.0 20.5 Vertical Glazing (Windows, Glazed doors using Exception 602.6#1) Plan Component Glazing Width Height Glazing �� Description Ref. U-factor Qt. Feet ���n Feet �"°� Area UA EXTERIOR WINDOW 0.32 1 2 6 3 6 8.8 2.80 EXTERIOR WINDOW 0.32 3 5 4 60.0 19.20 EXTERIOR WINDOW 0.32 1 4 4 16.0 5.12 EXTERIOR WINDOW 0.32 1 6 4 24.0 7.68 EXTERIOR WINDOW 0.32 2 2 6 5 25.0 8.00. EXTERIOR WINDOW 0.32 3 5 3 45.0 14.40 EXTERIOR`WINDOW 0.32 2 2 2 6 10.0 3.20 EXTERIOR WINDOW 0.32 1 6 5 30.0 9.60 EXTERIOR WINDOW 0.32 1 6 4 � 29.5 9.44 EXTERIOR WINDOW 0.32 2 2 6 2 6 12.5 4.00 EXTERIOR WINDOW 0.32 1 3 5 15.0 4.80 EXTERIOR WINDOW 0.32 2 2 6 24.0 7.68 Sum of Area and UA 299.8 95.92 Area Weighted U= UA/Area 0.32 WSEC Prescriptive Worksheet(2010 Edition) WSUEEP10-010 Copyright 2010 - ----- ----- •� Plan Component Glazing Width Height ID Description Ref. U Qt. Feet '"0n Feet �"°n Area UA SKYLIGHT 0.32 1 2 4 8.0 2.6 Sum of Area and UA 8.0 2.6 Area Weighted U= UA/Area 0.32 Doube Gtazed Garden Windows Section 602.7.2 Exception Plan Component Width Height ID Description Qt. Feet '"°n Feet �"°n Area UA Sum of Area Sum of Area X 3 (This total is automatically inc/uded in the glazing area total.) Glazing UA for Heating System Size Only=Area X 0.63 WSEC Prescriptive Worksheet(2010 Edition) WSUEEP10-010 Copyright 2010 �....p,... ...........y vyuw�n v�c.c. v��n�atc�V��� � Project lnformation Contact lnformation Plan 1922-2 Puget Sound Builders Associatior 1922 sf 2 story Yelm WA indoor Design Temperature 70 Outdoor Design Temperature 21 Design Temperature Difference (�T) 07=�ndoor-Outdoor Design Temp 49 Conditioned Fioor Area 1922 Conditioned Volume 15273 Glazing Copy Sum of UA from Glazing Schedufe 119 Attic U-Factor X Area = UA R-49 O.d27 1108 29_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-Facfor X Area = UA R-21 0.056 2246 125.8 Floors U-Factor X Area = UA R-30 0.029 814 23.6 Below Grade Walls U-Factor X Area = UA 2' Depth Walls 0.042 3.5' Depth WaJls 0.041 T pepth V1lalls 0.037 Slab Below Grade F-Factor X Length = UA 2' Depth 0.59 3.5' Depth 0.64 7' Depth 0.57 Slab on Grade F-Factor X Length = UA R-10 2' perimeter 0.54 R-10 Full- Heated 0.55 Sum of UA 2gg Envelope Heat Load 14615 Btu/Hour Sum of UA X OT Air Leakage Heat Load 8082 Btu/ Hour ((Volume X 0.6)X�T)X.018)) Building Design Heat Load 22697 Btu/Hour Air Leakage+Envelope Heat Loss Building and Duct Heat Load 1.15 26102 Btu/Hour If ducfs are located in unconditioned space:Sum of Building Heat Loss X 1.15 ff ducts are located in conditioned space:Sum of Building Heat Loss X 1 Maximum Heat Equipment Output 150% 39153 Btu / Hour Building and Duct Heat Loss X 1.50 WSEC Prescriptive Worksheet(2010 Edition) WSUEEP10-010 Copyright 2010 ALPHA ENGINEER/NG �2741 111 T" Ave E Puyallup WA 98374 253 241.3334 March 25, 2013 Attention: City of Yelm, Building Official Puget Sound Builders (PSBA Homes) is authorized to submit our Plan # 1922/2 for a basic plan process on Lot 171 In Tahoma Terra. Any revisions or alterations must be authorized by Level Design LLC prior to commencing work. Sincerely, George Gergis P.E. Civil Structural GEO Technical �CE��IED MAR 2 7 2013 '�'/".T. ^-_=' � � �.e�. .��„.�.a.o GEDRG� GERGtS, P.E. � ClVIL-STRl1CTUR��-GEO TECHNICA� � 12741? ?��`"A�e E ►�uyallup,WA 98's74 (253�241-33;� . _ .,� - - - _- STRUCTURA►L CALCULATIUNS For Level Design, Inc. 1 Q/i�l2012 �3���:11 � Engineered By: Gearge Ger�is,P.E. Client: Level Design ; 6I I �al�ima Ave '�� , � '1 �_`� Nr Tacoma, WA k � � `;`• \ � f' t� ��. , � k�a Project: Two St�ry Sin�le Family Residence _�} � ' ,�- � Site Address: Basic � . t�a� ���� �,_ , ��ri Architectural Design by: Level Design Plan 1922 Code: II3C 2009 Roof: DL: 15psf,LL: 2�psf Ftc�c�r: DL: lOpsf, LI�. 40psf Seismic: Zone D Wind: 85 PMH, Exposure B Soils: Type D Note: 1- Calculations are Iimited to the gravity and lateral of the tu�o stary structure SFR 2- They are not valid without original stamp. 3- See placTS for details __ ___._____ r �--� ���L� X ��� ,�•C t3�?_� �.��� , /~'r� � f—�' -( ;' `� - l ��c� ���0� "� �� �' J �,;, t-"� � � i`� , r .t— ��.�: �rr . �%; T;v;_� , _�, �cn?o ��C}c'� `Z,t-r-' )-� � ��.1:r.,f,(— ,'r ��•�-�� ' _.-.-�- ��. - ��---��,�: � ' `s z�'�-c...c.� ��QG`' c �°, .��" `- ,�'j-y''{_°� � r�� '`�' � �_ � �-� t 7:'� ,} � � .�,' -���` ��- — N � v�� ,�f.`` �Y- ��---��'1,-�j �: =-X` ,.� �4 , l �� �� ��Y,' � T c-�-1�r�,C � � . _ .�� r , ���-t. r �r � f��t t?c� �S� �, �.� C � ��� ��at.s ,� �� � �,� � � /y7' �^n � C=7i bli�J� ��'1�'� 5-�-�a R � � / t {/1 � ,./rt,f jI��- � ��}���. . v ft � ` '� j'� �'.. �'� : t ��`-'�� e;�' !"'�`'{ J 1 i /� � � =t- �""G�tl p,e.;�r C�. 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Figure 5-2 � � G Desi�#}�ed Pressures =-- -• ^ '�' ° � _- �� ,ti-����!��� ... `� - 't ��. � - _''- �} �� I ���������� � �, - . � [ '�� y�\ I ' ��� jfl �,t ; � � I � � ���� 1- � ' �' '�''��� ( i ���; , i ,�, -:��� �� i ' � � '(�J � � { i a f� G � J� � � t � ' ' _ �,-� f::� , _ ; i-- �- � �'�f f-��. ���- "f�� . � 3 ; - _ �:�� � � �� � t�.;� � � �. _ � i '�" � � � >>. " $ �a � - —;��" o � � � �-� � \ _ '-. ~ � —' � �; � _ y i � �� � �4 � :, � �`„ C� i. i �,f `� ��� ,..�'a� : 1 i � =- _. ,. �� � -, } , �,ce��-i ,� ' '� � 4 C.� - � A �� t ���SY�.�t.ei ` � `.��� , �,f�!/�"Y� / r•�. ` � =.,�" � p . ,�� � � �' ` �it+ ��� . � _ C / `` � f �t� � � � . Cm�s �� � `1 � r �� � �..Of1JltttiE�lfiB� _. �/ F. ti<d ,: �.. NOtCS: � i_ p���S�,n�e app6ed to the horizons-ai and vercical projecdons,for espesure B,at h=30 ft(9.1 m),I=1.0,and Kn=i-0- Adjust ta ot�r conditions usinS E9t�ati°°6-i. ?. The ioad patterns shown si�all be aPP1�ed t°e�ch corner of tfie building in rurn as t�e referec��e carner-(5ec Fignre 6-Id} 3. For the design of the longitudinai Ivf WFRS use @ =0',and tocate the zone E`F,CJH boumiax Y at the mid-length af the buildvsg. E �. Load cases i and Z must be checked far 25°<9 <_45`. Load case 2 at 2�°is provided oniy for interpUlarion betweeu ZS°to - ! >. Plus aud minus signs sig�nfy Ptess�aes act'vxg roward aud away from the projected sacfaees,res�ex.-tivety. 6_ For roof slopcs ether than those sho'uu,lin�-a�inferpoiarion is pe�mitted. 0 in zones B&D. 7_ The tflral harizonreE ioad s6ali�t be less than#hat deYermmed by assumimg Ps= 8_ The mne pre.ssnres reP'esent the fol3owing: resssues on vertical pmJer.tiun o� Horizo»tal piessute zones—3tmm of che windward aad I�a�or zone of wall emal and exte��al)P q_ E,nd zone of waT� B- End zone of raof U- ]nteriar wne of mof VeriiraI�uxessss�e zanes—Net{s�un of intetnai and extera�a!}pressuc�s on horizonral projecuon of. E- End zcme of wirtd�vard roof G- Interior zone of windwattt roof F- End zone of teeward roof FI- Interiar zone of ieeward roof 9. Where zone E ar G fails an a roaf averhang on the w-iadward side af she buildiag,ase Erni and G�c+for che pressure on the trorizonrat grojectian�f thc averh.wg. O�ert�an�s on the ieeward and side edges shall have the basic zone press�ue applied 10_ Notation: a: 10 perce[1t of least harizontal d�me°sion or 4.4h,whzchever is smaller,hut not iess t�an zithsr 4%of Eeast horiumtal dt�mensios� ar 3 ft(09 m}. h= Mean anof heighc,iu feet{rnetersj,except that eave heigtit�haEl be nsed for coof angles<10°. 9• Ang�e of plane of roof fi�om harizofltal,in degzees- �� ... - . n_�•��� �...i..fnr Quileiinnc 9eai('khnr Ctnvt��rea� .... __ . . . . ..... . ...... . .__._ . .. ... _ �_ __._.. 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N � �' � O N � (a Q��tglE o- � � � � J � _ �U � z � t0 � � � � � � a; = Z Q � (a t� � � � � c c � � � �� � ��4��a m O O m � Q cn m � , , . .. , , , . ` i.5 .. _ , <. � ti._.� �.�; ;'; , �.��,� . � �._,; , , __,; ,� ���, , . ��_,; , �. � ,� , � � , � � - .a�� ���s 0 � � 9 '9 � � V , Duct Leakage Affidavit (New Construction) ` Permit#: "`��� � f� i G `_ � C�tr' ' � �' ��; House address orlof nutnber: 1 "� "�•_? � �7�� `"�`�`-- `� City: �`! � tr��`\ Zip: �f����j l Cond. �Ioor Area{ft2): /��Z- Source{elrcle one): �ans, Estimated Measured ❑Duct tightness testing is not required.7he total leakage tesk is not required for ducts and air handfers located entirely within fhe bui(ding thermal envelope. Ducts located in crawi spaces do not qualify for this exception. Air Handler in conditioned space?�]yes j] no Air Handler�resent during test?Q yes[]no _...__....._. Circle Test Method: Leakage to Outside T �aF L"eakage. �_ .__ Maximum ducf Ieakage: Post Construction,totat duct teakage: (floor area x.04)= CFM@25 pa Post Constructton, tea[cage to outdoors: (floor area x.04)= CFM@25 Pa Rough-In,tofaf cluct ieakage with air handler installed: (floor area x.04)=�CFM@25 Pa Rough-En,tofaf cfuct[ealcage with air handler not instailed: (floor area x.03)= CFM@25 Pa Test ResuEt. `r> � C�M@25Pa Ring(circle one if applfcabfe): Open 1 ��� 3 , ; _ ; � Duct Tester Location: 1` f rr Pressure Tap Location t �=� Y� '`�'-� �i�'� -�" r��%'% � I certify that these duct leakage rates are accuraf�and determfnecE using standard duct#esting protocol. � i ` � ,t. Company Name: I ��t� E:�Y�!--'',``"��� 3�> `-`'j Technician: �.i 1 �-t`�.`L`"� I ;,_) - �� .,. �_.. Technician Signature: '` } ` Date' '"7..j;l ._. j 3 Phone Number: `� �� I���-`�-- ��