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HomeMy WebLinkAboutLA172358 � / � � .� � ffi�3 F&.��;�A��� � i.ta� _'�. .$�:.. _� t '�r °�if = ' �-� .�..z�$ ' :�,`. _ ` .f1 ?. ' .� �, t a • as a �� p �' � � t � r �s �: i � . a... �.s a - ,�-#�: "a e� :-31 .:a a 8.' v- a.' :3 '- } •t• •..! s 1 d s; 1 WD � e' !-ra a: ,p a` �'e k0 b�:.d 'I i A. :..#' ' '�i � ��:.:a s�i r ��: f-. � e � : e ' �i -r�+ � r � � .r .i'D » s �-:.�:: � � 'T' I : }� �.t' f- 4.-, 1 li {: i � if Y�<�# �s �� i�l� - �' .4 $" �C":' � \S / ` �y � � g 7S e'� R '�� ' I '�4 . � � _/�� �b � �.�:�, a. :�a r:a : �, e a�; �1-:� x: c3 x � o�: 1 ' r?� � s.t : S • :. x: * • Y�: $ �_>- �� �, �� � . . ..:, � ,d� ` � ;► �� . , 4 �y F D{ r � ar " a �s 0� S� ` r ` - + °' r � ■ f .: .«t .a i �• iV !- ' �I 1� I * II ��I� � { r s. t:: � • � sr� :�i �'" �: I � \ � `- - _t� s e -e-i / � - � ��, I f "ae �! Y a_ !a, s=:.i=� s � Y �a E9 s w!� i.,. t � 'f' ' s— 3�� �/ �' � ,z�t�."It ��. �`" �_a.: . , / �anu�#a�red� �v�tem� Te�t A�i davit �is fc�rm mctst t�ctympteted in its entirety an�be submitted ai the 8u7ding Fina�insp�ctian far the ir:stallation af a nanufactured home. Aii tes�s must be completec#and s�gned�#fi an this form, A cer�`rfic�te af occc��nc�uvii! not be ssued u�ttil this completed forrn is received. � � � �� �� SYSTEMS 7EST YEEt�FiGAT1t'�►N Descrip#ion date�'assed S�na#ure vf Tester 3rain Lit�: Pt,rsuar�t to cFR 328tt.6i2{b) Date: �rint of Tes�er at�i Company: M$#�1`1..11'�: Pur�uar�#ta CFR 328t}.612(a) Rate: �rint N�te of TBst�'and Company: �i7Cp,lt'B T@S� Pt�arrt#o CFR 328U.612(c) Oate: 't�tt Ptame of fi�ster 8t�d Cocr�p�atty: �S T� Purs�rtt tt�CFR 32�3,705 arni IFGC 4Q6.4 Oate. ��{� r �irrt of T :as�ci Go�rtp�ty: �(�Y�U� ��jS� �C�..S`�T ��1��Q„��Q.��. ��� El��!l��7I@�E�C►t1�1l: Fursuautt to CFR 3285.T{}2 C►ate: 'rit�iVa�r�of Tester'a»d Corr�pany: :�b't#'iC�l Pt�i��'3t31: P�rrt#o CFR 328�.'�02 Date; 't�tt Nam�of Te$ter�ui Ccxnp�r�y: :�C�1 Ct1►t��ltttty: Fsur3t,�e'tt to CFR 3285.702 L7a#e: 'ri�Nar�e o�Tsster and C�cr»pa+iy: �1'ttlk@ A1�!!'tt'!T� Put�uat�t#o CFR 3280208 �3a#e: 'rir�t N�e of T ar�d Ccxr�any: ca�ifjt ti�e s ' I�s be�ccxr�pFe�ed�t w��.tc�d t�be in ccx�tp' with� ' 't>t�a icten#�ed�ar e� Y � re: D et�' " � �