HomeMy WebLinkAbout4914 Cemetery Rd_BLD046199_2025 Q INSPECTION REPORT
4y1N G p0 Permit No.: o y 6t 4g Lot#: / z
Q Address: 4 R ► Cf Ce �y
Contractor:
�s ,SO Owner: �v �-S a yj
�jN� Date: rD - 2-6 -0L/
0-APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ❑ CORRECTION REQUESTED
❑ Corrections listed below MUST BE MADE before work can be approved.
❑ Please contact inspector.
❑ Was not able to perform inspection.
❑ CALL 435-0674 FOR RE-INSPECTION - 24 hour notice required.
Inspector: 7} Date:
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ;q Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
G I TY aF ARL I P4 C3-rUP1
GOhlST RIJGT I UP4 PE RM I T
PE Ft I T NO_ n 12)1Z+—E:' 1 9 9
Orner: NIELSEN, SUSAN 4914 CEMETERY RD ARLINGTON 98223
Value of Work: $500. 00 Tax ID: Phone. 360. 435. 3882
Describe Work: INSTALL GAS PIPING AND STOVE
Proposed Use: SFR
Legal Description:
Job Address: 4914 CEMETERY RD
Contractor's Name Type Address License#
OWN
P E R M I T F E E S
Equipment and Fixtures Number Fee Total Charge
------------- ---- ---- -- ---------------- ------ - ---- --- ------------
METAL FIREPLACE & CHIMNEY 1 $11. 00 $11. 00
GAS PIPING 1-5 OUTLETS 1 $6. 00 $6. 00
S U B T O T A L. . . . . . $17.00
TOTALS Fee
Equipment $17. 00
Mech Permit $24. 00 aN�.
SIGNATURE:
TOTAL FEE. . . . . . . . . . . . . . . . . $41. 00 I HEREBY CER 1rY THAT I HAVE READ
AND EXAMINED THIS APPLICATION AND
PAYMENTS. . . . . . . _ . . . . . . . . . .50. 0 KNOW THE SAME TO BE AND COR-
RECT ALL PROV ION LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . $41. 00 ORDINANCES G V RN G T IS TYPE OF
WOR WILL E C MP I WITH WHETHER
P FIB E EIN, 0 T.
DATE RECEIPT #
� � IN OFF CIAL
CITY OF ARLINGTON
CONSTRUCTION �a
PERMIT �l G y
❑ COMBINATION ❑ BUILDING 4 MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.
OWNER MAIL ADDRESS CITY ZIP PHONE
49&.a3-
ARCHITECT OR DESIGNER MAIL ADDRESS CITY zip PHONE
Ou�Y\",
GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF
f w y\
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE#
CLASS OF WORK
❑NLW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMULI FION [:]BUILDING RELOCATION
VALUATION OF WORK
f
DESCRIBE WORK
n
PRUKSk D USE OF BUILDING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
0TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLUALDEM RIPT ION Of PROPERTY(SHOWN BELOW UR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LOT la BLOCK - OF WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO
VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
TAX ID NUMBER LOCAL LAW REGULATING CONSTRUCTION OFTHE PERFORMANCEOF
CONSTRUCTION. PERMIT EXPIRES 1 YEAR FROM DATE OF I SUAN.CE.
SIGNATUREOF KIPACTOR OR AUTHORIZED AGENT DATE /C ;o 2
108 AUURLS {/
X"?N 'll
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(OFFICE USE ONLY)
MECHANICAL
PLUMBING
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
WATER CLOSEI (TOILLI) AIR COND UNITS -HY EA.
BATHTUB REFRIGERATION UNITS- H.P.EA.
LAVATORY (WASH BASIN) BOILERS- H.P. EA
SHOWER GAS FIRED A-C.UNITS- TONNAGE EA.
KI ICHEN SINK& DISP FORCED AIR SYSTEMS- B T.0 MEA
DISHWASHER WALL HEATERS- B.T U M
LAUNDRY TRAY UNI1 HEATERS- B.T.U. M
CLO I TIES WASHLR EVAPORAI IVE COOLERS
WAILRHEATER CLOTHES DRYERS
URINAL VENTILATICN FAN
DRINKING FOUNIAIN RANGE HOOD COMMERCIAL
I'LUOR DRAIN AIR HANDLING UNIT- CPM
VACUUM BREAKERS SFOVE
ROOF DRAINS - RAINLEAUERS METAL FIREPLACE&CHIMNEY
SINK (SERVICE - BAR,ETC.) WATER HEATER
GAS PIPING
SUB TOTAL f SUBTOTAL f
PERMIT f PERMIT f
TOTALFEE f TOTALFEE f
SIUL YARD SE I BACK STRELT SLTBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE
FEE RECEIPT NO.
USE ZONE LOT AREA VACANT SITE
FEES VALUATION FEE
❑YES ❑NO
TYPL OF CONS] OCCUPANCY GROUP NO.OF DWELLING UNITS PLAN CHECKING NG
BU'LDING f
SIZL OI BLDG. NO.OF STURILS MAX,OCC.LOAD
PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES ❑NO MECHANICAL
STATE BLDG.CODE
COMMENTS ENERGY CODE SURCHARGE
PENALTY SECC303(a) 1
WATER/SEWER FEES
TOTAL
PERMIT VALIDATION
WHEN PROPERLY VALIDATED IIN THIS SPACE)THIS 15 YOUR PERMIT&RECEIPT
PAID CR# BY
BUILDING OFFICIAL DATE
cc:ASSESSOR,APPLICANT,TREASURER,BLDG. DEPT RECORDS COPY