HomeMy WebLinkAbout423 CLARA ST_004277_2026 INSPECTION REPORT
4N Gj, Permit No.: OV—.573`,tot #:
Q' Address:
• • R. v 7�a �C aJ -
Contractor:
O Owner:
�s4FN Date:
_ G— C
PROVAL ❑ PARTIAL APPROVAL
ClujVIOLATION ❑ 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: _ Date:
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in WFinal
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
MN INSPECTION REPORT
O,ONGPermit No.: L�L> a ) Lot#:
Address: 4
Contractor:
Owner: <.Date: - I
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: Date/ i
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ truct. Slab
❑ Wood Stove ❑ Rough-in Final
❑ Masonry ❑ Drainage ❑ nsulation
AA INSPECTION REPORT
I�+�N G - 7 #:
lG Permit No. Lot: � y�'
Q" Address: a all
� Z Contractor: _
�® Owner-
4ING Date:
- -APPROVAL ❑ PARTIAL APPROVAL
`0 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:
Date.
TYPE OF INSPECTION REQ ESTED
El Under-floor ❑ Framing Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ onsultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage Cl Insulation
❑ Other:
City of Arlington
Permit No.
NOTICE card Inspection Report
Date Called `f Address
Time Called l Contractor/Owner i
By Requested .
TYPE OF • REQUESTED
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
❑ Footing ❑ Framing ❑ Woodstove
❑ Foundation ❑ Drywall Nailing l Final
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other_
APPROVAL ❑ CORRECTION REQUIRED
—ram —
❑ Corrections listed below MUST BE MADE before work can be approved.
t��4ork listed below has been inspected and approved.
❑ CALL 436-0724 FOR REINSPECTION-24 hour notice required.
Inspector Date
City of Ar]i ngton
Permit No.
NOTICE and Inspection Report
Date Called Address 42—,-Z ��
Time Called Contractor/Owner
By _ Requested by
TYPE OF • REOUESTED
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
❑ Footing ❑ Framing ❑ Woodstove
❑ Foundation ❑ Drywall Nailing al
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other
APPROVAL CORRECTION REQUIRED
orrections listed below MUST BE MADE before work can be approved.
❑ Work listed below has been inspected and approved.
❑ CALL 435-0724 FOR REINSPECTION-24 hour notice required.
G � A
D
Inspector ate
City of Arl ; ' - gton
Permit No. '
NOTICE and Inspection Report
Date Called � I )J Address
Time Called ContractodOwner 2 ?a Y P
By `�}, Requested by a
O
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
❑ Footing ❑ Framing ❑ Woodstove
❑ Foundation ❑ Drywall Nailing ❑ Final
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other
PROVAL ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved. _
Work listed below has been inspected and approved.
❑ CALL 435-0724 FOR REINSPECTION-24 hour notice required.
6 r
Inspector Date
Permit No. �� �C� City Of Arl tngton
- NOTICE and Inspection Report
Date Called tj Address 1''R"-3
i
Time Called � g / Contractor/Owner
By Requested by
TYPE OF • REQUESTED
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
❑ Footing ❑ Framing ❑ Woodstove
aX Foundation ❑ Drywall Nailing ❑ Final
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other
APPROVAL ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved.
t5z__Work listed below has been inspected and approved.
❑ CALL 435-0724 FOR REINSPECTION-24 hour notice required.
r
Q'
Inspector Date v
Permit No. ?C7 cif, n, A m iA'N,*7,rO N
NOTICE and Inspection Report
Date Called / — Address
Time Called ���w Contractor
By J Owner
Requested by
I TYPE OF INSPECTION REQUESTED
e�
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
❑ Footing ❑ Framing ❑ Woodstove
Foundation ❑ Drywall Nailing ❑ Final
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other
PPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved.
Work listed below has been inspected and approved.
❑ Please contact inspector and arrange for appointment.
❑ Was not abbe to perform inspection.
❑ CALL 435OR REINSPECTION—24 hour notice required.
Inspector Date
I was present during this inspection.
Permit No. l d city ni MAIL It IA I N•"7'4t N
NOTICE and Inspection deport
Date Called c�� Address
/,
Time Called J Contractor �ez.? z�A1 .17z;r&/11
By ��` Owner
Requested by
TYPE OF INSPECTION REQUESTED
❑ Setback ❑ Reroof ❑ Insulation
❑ Plumb GW ❑ Roof Diaphragm ❑ Gas Piping
Footing ❑ Framing ❑ Woodstove
`Foundation ❑ Drywall Nailing ❑ Final
❑ Concrete Slab ❑ Rough-In Plumbing ❑ Reinspection
❑ Shear Wall ❑ Furnace ❑ Other
PPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved.
\listed below has been inspected and approved.
❑ Please contact inspector and arrange for appointment.
❑ Was not able to pe•orm inspection.
e,'�I
❑ CALL 43 OR REINSPECTION—24 hour notice required.
/
Inspector Date
I was present during this inspection. /
G I T`f Q 1= €:1 R L- I P4 CG-IF C)t 1
CONSTRUCT I C7tV PIFEFRM I T
PER1-1 I T NO _ = 04--!zi93Zr
Owner: ALGARD, SKIP 423 CLARA ST ARLINGTON 98223
Value of Work: $100. 00 Tay: IJ: 006169-000-002-00 Phone: :360-435-'2,637
Describe Work: INSTALLING -CLEAR OUT IN SEWER LINE
Proposed Use: SFR
Legal Description: WROBLISKI LOT 2
Job Address: 423 CLARA ST
Contractor's Name Type Address License#
JOHN EILASSER FLi, 6624 236TH ELASAJE033D4
TOTALS Fee
Plumb Permit S25. 00
SIGNATURE:
TOTAL. FEE. . . . . . . . . . . . . . . . . $25. 00 I HEREBY _Ri i Ir Y THAT I HAVE READ
AND EXAMINED THIS APPLICATION AND
PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 KNOW THE SAME TO BE TRUE AND COR-
RECT ALL PROVISIONS OF LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . $25. 00 ORDINANCES GOVERNING THIS PE OF
WORK WILL BE % R -LIE- WI_ . WHETHER
SPA FIE ,l OR
DATE RECEIPT # 1B3 1 1 1NIG OF i IAL
G I-rY ELF A RL I NO-rON
CONE3TRUCT I ON PERM I T
BERM I T No-
�.r*R't:tip_ ay. _� �` r.--�'t y.� _, .Pv_
Owner-. amp r.' :� t=_.t` : w q.C; =
Value of Wo�^k. _� ,,K o���
Descrit- Work: =N " 23,.,E -
Propos Use: ,1-S,i2CN7_`:_
Legal Csscriptior:o
,lob Address. -:`C 2'
Contractor's Name Type Address License#
3 x
P E R M I T F E E S '
t Equipment and Fixtures- - - - Number Fee-- Total Charge
METAL
ETs AL r_SEP AGE I CH'" BEY
s ? ' _FlD1
—4 QUT_ET::
SUBTOTAL.. ...
TOTALS Fee
5IGh1ATURE:
TOTAL FEE,.............. . .. #41.M
!L T� D Ti'i TS efts.= '7ATIGN ;q.Kil
ate*'Y s. l.7!'S ,.n:J
PAYMENTS........ .. ........�@.0 '- ^YE!Tr B
— ter: .G i�,.. .,L ;vi• 1rr :
-- r-Y'! •! r�4•+ � - W1543P1
TOTAL DUE....... .......... 341.30ir
r I .4 L
ZE
7M1 A'i R— PT t J11'
CITY OF ARLINGTON
CONSTRUCTION
PERMIT
CbM61NAT10N ❑ BUILDING NEC11ANICAL ❑ PL.UPIRING ElSIGN PERMIT NO•`r+ a /
L ALSS C11Y Z�► rf10NL V
OwLR QP i MAN GGn f' �I'�zZ>
A�� 5� L-,1v T6pj
~i ! CITY zip
MUNI.
ARU IIILC10 R EESI(:N MAIL AOORFSS
G:`IE RAL CQN AC U
MAIL ADDRESS CITY 1(► ►ItON LfC H f
CITY 7..IF P1(CINE LKCNSE
MLUTANICALCDNrRACTDR MAIL ADDRESS yZ5
lifl. C Pu trn 1Ni� �{r�.. PCB Eex iL%2/ `yn1/^Q4 i1 rC1 CITY 11P _ ?�5 �to�l l�/�'�'N PltGtilNc:ryt
SS FICHE LIC(NLE
r MAILAOORE
Lun(o1NLCONTRACTOR G6 �G
CLAS50r wURK
rQNEW ❑AUDITION ALTERATION �RE►AIR ❑UETAULIrION []BUILDING RELOCATION
4 ,,LUATIOMOF WORK
x , 2 360-670
DLStRI E WURK
�1�5 i/�LGI nl(r c%� lam•.-EpLA� �n/v�;
nuPvsl o Lnt of eultlNHG I HEREO CERTIFY THAT I HAVE READ AND EXAMINED THIS A"LICA-
w N T1ON►NCI iCNnW THE MME TO BE TRUE AND CORRECT ALL PKOVI•
ZLL,ALbt\(Rlr(IUNV1 ➢R(yLIETY($IfO�•nK£LO�• AIIALIfUiRCOP1f5; SIONSOF LAWS AND ORDINANCESGOVERNINtiImSTYPlOFWORK
WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE
La1 NLVC K CWGRANTING OF A PERMIT DOE5 NOT PRESUME TO GIVE AUTHORITY TO
a
� VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE A
W srxl Iaa1:K T'HllM FAbrl41TY TAX E?AT6UCNT LOCAL LAW REGULATING CON5TRUCTION OFTHE PERFORMANCE OF
�l CONN I KUCTION.PERMIT CXVIRES 1 YEAR FRf_1M nATF Of 155VffiCE•
iJ� d
SIGNA7UR40rCCN+SRA.^TOR/ORALI'F+'C7fJ2 VA-If
UjQC.L'JUR r Gt ` _ q 2�'1610
(OPPlcg VS3ONLx) WIANICAL,
PLZ;MSI1:0
No. TYPE OP F1)CTL ti3
PLt6 :1trTXT11RE3 NO. T'YrBCFeQVIrMT2IT pr�1
AlSRCLOSTTT S
' iICt:ON0.LT4179-H.►. P.L.
LET ,Rr•"
/Cr1ITUS 1oT4tATT9N UNITS-ll.r.BA.
.N.YATORY A511 UAS1N OC.tiK3-fi.i'.EA- 1 ,a..•'
'Hoax
AsrrRtmA.c.uNtts--roNe+Ao(se�+- .nt••
11sx SINS�D1ST08AL oR�O IR srsTz>�s-n-'r.u. NCTA
y7(WASTi3R ^U 11&ST'+�..SLS-ELT-U. M
NDRYIXAY NIT IS -e-T.U.
Lo4'I rBi WASI�R AroRn71 tm coo 1-TR(s
ATCR I TVAT ER T O i t I tLS DR Y[T:LS
txAL _ WIll-A-roN PAN
INGNd RdUNTA1N a Tt0OD COMLSR'-
}npOR DRAIN ITT IfA NDUNU UNIT CrM
NADVVIA MUVYiSR5 tT
�it?Or 5-TWNLCADBR& I rrALF1APrLACL't clr1MNCY
NK e6RVTC 3Ax.$- I ATM 1IZATM
ASP1rLH w; Rf.aO,♦fJwL-TTS
I
sun TOTAL
SUB TOTAL MM17
rIMMIT —
TvrnL rea :oTAL rl;g
PLAN NVMNER PLAN CHECK FEE
SW4 YAR!]SLI$jALK 51RETI $LIBALK RRARYARDSETBALK FEE IRCEI►TNO.
us1 JLNt Lot Akt A VACANT SITE PEES VALUATION FEE
Q YES p NO
TYPL OF CONS 1 ()CCUfANCY GRUVi NO.OF DWELLING UNITS R111'1 CFiECK1NC 4G
BUILDING f
SI/L OI GLU(-, Nu.Or STOR11.s MAx,O[C.LOAD
I
PLUMBING
1:Rt 5;`RtNKLLRS RLOVIRfO
MECHANICAL
COMMENTS STATE BLDG,CODE
ENERGY CODE SVRWARGE
PENALTY
sec.soxd
WATEWS[WER FEES
TOTAL
IPERMIT VALIDA71ON
WWN f'ROrERLY VM"TED aN THLS SPACD TWS 61'WR PEItMTT i RECEPT
PAID CRN - BY
cc:A55CS500t APPLICAMT,TReA5UFmn.BLDG DEPT OtItL31mr.0; '^L DATE
RECORDS COPY
CITY OF ARLINGTON
CONSTRUCTION
PERMIT
❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.00628
OWNER MAIL ADDRESS CITY ZIP PHONE
Lorenz & Leanne Algard 423 Clara St Arlington 98223 435-2637
ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONL
Tn3,nn7- Al crarr7
GENERAL CONTR��mTUR MAIL ADDRESS CITY ZIP PHONE IICENSE0
ME ^I�SCONTRA OR MAIL ADDRESS CITY ZIP PHONE LICENSE I
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N
CLASS OF WORK
❑NLW I[]ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑BUILDING RELOCATION
VALUATION OF WORK
; 54,066.76
DESCRIBE WORK
"L" off the back of single stomy rambler.
PRUPOSt U USE OF BUILDING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
Dwe TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LOi 2 BLOCK I 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 OF THE PERFORMANCE OF
CONSTRUCTION. PERMIT EXPI 1 YEAR FROM DATE OF ISSUANCE.
SIGNATURE O ONTRACTO R LITHO EDA ENT DATE
jOB ADURI SS
A?l Cln-rA q+- x at
(OFFICE USE ONLY)
PLUMBING MECH NICAL
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
WATER CLOSET (TOILET) AIR COND.UNITS - H_P.EA
BAIHTUB REFRIGERATION UNITS-H.P.EA.
LAVATORY (WASH BASIN) 2 00 BOILERS- H P. EA
SHOWER GAS FIRED A C.UNITS-TONNAGE EA.
KI TCHEN SINK & DISP- FORCED AIR SYSTEMS- B.T.U_ MEA
DISHWASHER WALL HEATERS- B.T.0 M
LAUNDRY TRAY UNIT HEATERS- B.T.U. M
1 CLOTHES WASHER 2 00 EVAPORATIVE COOLERS
WATER HEATER CLOTHES DRYERS
URINAL VENTILATION FAN
DRINKING FOUN I AIN RANGE HOOD COMMERCIAL
FLUOR DRAIN AIR HANDLING UNIT- CPM
VACUUM BREAKERS STOVE
ROOF DRAINS - RAINLEADERS METAL FIREPLACE&CHIMNEY
1 SINK (SERVICE - BAR,ETC.) 2 00 WATER HEATER
GAS PIPING
SUBTOTAL $1 J-0 UU SUBTOTAL $
PERMIT $1 15 00 PERMIT $ 15 00
TOTAL FEE ; 25 00 TOTAL FEE $1 24 00
SIDL YARD SE I BACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE
5 5 28 27 FEE RECEIPT NO
USE/ONF LOT AREA VACANT SITE 5 10---91 1,05.30 23636
❑YES jj NO FEES VALUATION FEE
TYPE OF CONST OCCUPANCY GROUP NO.OF DWELLING UNITS PLAN CHECKING VG 284.05 --178 75
VN R3 BUILDING $( 437 .00
SIZE OF BLDG. NO.OF STORIES MAX.00C.LOAD
1193 2 10 PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES NO MECHANICAL 24 .00
COMMENTS STATE BLDG.CODE
ENERGY CODE SURCHARGE 4 .50
PENALTY U B.C.
SEC.303(a)
P A I TD WATER/SEWER FEES
TOTAL
FFq
PERMIT VALIDATION
WHEN PROPERLY ALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT&RECEIPT
PAID CR# BY
I A' O&d
cc:ASSESSOR,APPLICANT,TREASURER, BLDG DEPT LL ,GOFFlGAL DATE
RECORDS COPY
CITY OF ARLINGTON
CONSTRUCTION
PERMIT
❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.
OWNER MAIL.ADDRE55 gTY ZIP PRONE
L o I�EN 2 L«�yNC AL Grnr�O ,�23 ��R,�-i �UAJ 6 0A) �I�f`Z
ARCHITECT OR DESIGNER ` MAIL ADDRESS CITY TIP PHONE
L o2EIL22 'IL(f"Ixe J
GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LIC NSE N
45 O I"-ti 6
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP. PHONE LICENSE N
CLASS
WF WO RK
❑ NADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑BUILDING RELOCATION
VALUATION OF WORK
s J A e . 7li
DESCRIBE WORK
ar
PROPOSE D USE OF BUILDING
�c�CLLl,U L-s I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLGAL ULS(,RIPI ION Of PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LOT Z BLOCK I OF 1i1P0 i3L 15 i AD6 i rIOAf 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 OF THE PERFORMANCE OF
_ _ COz _ �a� CONSTRUCTION.PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE.
(C� SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE
LOB aUURLSS -
L1l X )
(OFFICE USE ONLY)
MECHANICAL
PLUMBING
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
WATER CLOSET (TOILET) 'L AIR COND. UNITS -II.P. EA,
BAIIIIUB REFRIGERATION UNITS-H.P.EA.
_+ LAVATORY (WASH BASIN) BOILERS-H.P.EA
SHOWER GAS FIRED A.C. UNITS-TONNAGE EA.
L.,:5'!- w U;sr. FORGED AIR SYSTEMS— B.T U. MEA— _V _
DISHWASHER WALL HEATERS—B.T.U. MJ _
LAUNDRY 1 RAY UNIT HEATERS— B.T.0 M
CLOIIILS WASHER y EVAPORAI IVE COOLERS
WAIER HEATER CLOT HESDRYERS
URINAL VENTILATICN FAN
DRINKING FOUN I AIN RANGE FLOOD COMMERCIAL
FLUOR DRAIN AIR HANDLING UNIT— CPM
VACUUM BREAKERS STOVE
ROOF DRAINS - RAINLEADERS METAL FIREPLACE&CHIMNEY
SINK (SERVICE — BAR,ETC.) 4111,_ WATER HEATER
GAS PIPING
SUBTOTAL S b SUBTOTAL f
PERMIT PERMIT 3 S
TOTAL FEE f f\ TOTAL FEE f
SIUL YARD SE IBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER C� / PLAN CHECK FEE
S Q 2 /O `/ / FE/O `9O RECEIPT N����
USt ZUN LOT AREA �f VACAN•TT SITE �LJ1 !J- `/J
❑YES NO FEES VALUATION FEE
TYPL OF CONS1. OCCUPANCY GROUP NO.OF DWELLING UNITS PLAN CHECKING NG ¢�D5
SIZE Of BLDG. NO STORIES MAX.00C.LOAD BUILDING f 3
10 PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES O MECHANICAL
COMMENTS STATE BLDG.CODE C•0
ENERGY CODE SURCHARGE
PENALTY U.B.C.
SEC.303(a)
WATER/SEWER FEES
TOTAL 6 q �5-
PERMIT VALIDATION
WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT 6 RECEIPT
PAID CR# BY
cc:ASSESSOR,APPLICANT,TREASURER,BLDG.DEPT. BUILDING OFFICIAL DATE
RECORDS COPY
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