HomeMy WebLinkAbout5813 CIRCLE BLUFF DR_024909_2026 INSPECTION REPORT
4ti1N G T'O Permit No.: d 2- ti Sa 9 Lot#: 3 S
Address: 58 i 3 c a o
Contractor: 14 Aft P6
j N OHO Owner:
Date: 9-9 0`-f
541 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:
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 ' A Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
iio
PerrmmiQit''No.�U r g9'091 Lot #: 3Ad %WContractor: r�Ls>A /'X0IC
Owner:
Date:
❑ 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:
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 �inal
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
1S4
TOPermitNo.: '490 Lot #:
Address: 3Contractor:O Owner:
� Date: M`4 — O 3
&-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: y `�-/ Date:,�Z7 C 3
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing 1-Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
z' 110L
INSPECTION REPORT
4ti1N G?'O Permit No.D Z: 590n Lot#: -3-C
Q' Address: 5813 e 1&'o
Contractor:
9s, ,S4 Owner:
LINO Date: i(—/a-D3
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: 5 u7� Date: 1/_/D—0
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 ❑ Final
❑ Masonry ❑ Drainage Insulation
❑ Other:
-INSPECTION REPORT ', /,a„
—J
N GI,_ Permit No.: �y Lot#:
Q' Address: v
•
� Z Contractor:
O Owner:
�s4 j N G Date: Z "0
f 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: 1 1 4-®s
TYPE OF)�_Framing
INSPECTION REQUESTED
❑ Under-floor ❑ Gas Piping
❑ Footing Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
iIN
NG?'OPermit No.: �5 0� Lot#:Address:Contractor: f� tO Owner:
CsS Date: /o-L,q—0 3
❑` APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION �W CORRECTION REQUESTED
;1' 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.
i
S T71-ram' U C_fU"T
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 ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
�INI'�PECTION REPORT
¢titN G TO Permit No.: 11,9° Lot#: 35
4' Address: S& 13 B
Contractor:
ys, ,SO Owner:
IN O Date:
.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.
14 lay—
Inspector: -5 t-lew Date: 7-2,5-03
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
f--Z-Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
121 a -if
pk INSPECTION REPORT
¢tiZN G?O Permit No.: 49 01 Lot#: 3 5
Q' Address: S S I's G g�
Contractor: -
O Owner:
IN
C',S Date: O 3
❑ 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:
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
A Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
\n� INSPECTION REPORT-- � 006v4�m
�rl
¢ti1N G rO Permit No.: � g0 Lot#:
Q" Address: �—/ J
Z Contractor: '
9S
O Owner:INC',S Date:
od.,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: �"��`��
TYPE OF INS ECTION REQUESTED
❑ Under-floor ❑ Framing as Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
teed— ❑ Grid ❑ Struct. Slab
❑ Wood Stove Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT 833
v�
4*1N G?' Permit No.: L Lot #:
Q' O� Address: �� , C45'�D
Contractor:
O Owner:
9s�IN�� Date: — -03
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.
5
Date:
Inspector: t
YPE OF 1 SPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation Shear Nailing ❑ Groundwork
❑ Mechanical Al-Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
4tiZN G TO Permit No.: 42- 'f I0 S Lot#: -3-
Address: gS i 1, G 6.D
Contractor: I+�
� Z
O Owner:
9s�I N G� Date: � � s
APPROVAL ❑ PARTIAL APPROVAL
❑ OLATION ❑ 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.
5 v(
Inspector: rZ,�-�-` 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 ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other: 5 5
_ INSPECTION REPORT
);4
T Permit No.: / Lot#.
Address: 5� 3Contractor: H �Owner:
� Date: ��
APPROVAL Ll 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.
r
Inspector: -,IT Date: `� �2-—�%
TYPE OF INSPECTION REQUESTED
A Under-floor ElFraming ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
c 4w/ti1N ?'O Permit No.: Lot#:
4
Q' Address: .
ZContractor: e—
O Owner:
Kls4I N G� Date:
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:
PE OF IN PECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
¢A.,1N G?'O Permit No.: 9 Lot :
Q Address:
ZContractor:
ems, �O Owner:
41 N O Date:
Q 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.
G�
Inspector: Da
TYP OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
4y1N G?'o Permit No.:d�" `fgC Lot #: S 5
Q Address: S J 3 Ci���,� ,iSl �•b�
Contractor: C4 �of
O Owner:�s c�IN G� Date: l C�2
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.
=-' 00'4A y�,c Date:ZInspector:
t"�� �
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
0 Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
1,IN G?' Permit No.: — y��' Lot#:
Q' Address:
Contractor:
O Owner:
4I N G Date: L/
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:
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 ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
C I TY OF n"L_ I NGTON
CONST F2UCT I ON PE F2M I T
PE FZM I T NO_ = 02-49 09
Owner: GUSKOV, OLGA 1330 FIR STREET EVERETT 98201
Value of Work: $85, 000. 00 Tax ID: 00915800003500 Phone: 425-252-5092
Describe Work: NEW SINGLE FAMILY RESIDENCE
Proposed Use: SFR
Legal Description: THE BLUFF UNIT 35
Job Address: 5813 CIRCLE BLUFF DRIVE
Contractor's flame Type Address License#
OWN
P E R M I T F E E S
Equipment and Fixtures----------------- Number Fee Total Charge
-------------------- ------ -------- ------------
PLUMBING FIXTURES 10 $10. 00 $100. 00
FURNACE/UNIT HEATER 1 $15. 00 $15. 00
VENTILATION FANS 4 $7. 00 $28. 00
DRYER 1 $11. 00 $11. 00
WATER HEATER 1 $15. 00 $15. 00
GAS PIPING 1-4 OUTLETS 1 $6. 00 $6. 00
S U B T 0 T A L. . . . . . $175.00
TOTALS Fee
Permit Fee $945.65
Equipment $75. 00
Fixture $100. 00
Mech Permit $24. 00
Plan Fee $614. 67
Plumb Permit $25. 00 A
State fee $4. 50 �TOTAL FEE. . . . . . . . . . . . . . . . . SIGNATURE:
51,788.82 I HEREBY CY THAT I HAVE READ
AND EXAMINED THIS APPLI ATIBN AND
PAYMENTS. . . . . . . . . . . . . . . . . . $614.67 KNOW THE SAME TO BE TRUE AND COR-
RECT 4bi. PROVISIONS OF AWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . 01, 174. 15 ORDI?PLG ERN MG S TYPE' OF
SPEC OMP RIEM ITN AND
DATE` �°� RECEIPT i
BUI I CIAL
PA D
V
N
V
UNITS 35 & 36, THE BLUFF AT ARLINGTON,A PLANNED AREA
DEVELOPMENT, RECORDED UNDER AUDITOR'S FILE NUMBER
200107095007, RECORDS OF SNOHOMISH COUNTY,WASHINGTON.
UNIT 35 OWNER: Andrey& Olga Guskov
TAX ID NUMBER: 00915800003500
JOB ADDRESS: 5813 Circle Bluff Drive, Arlin on, WA
UNIT 36 OWNER: Rostislav& Lyubov Petrushak
TAX ID NUMBER: 00915800003600
JOB ADDRESS: 5815 Circle Bluff Drive, Arlington, WA
LEGAL DESCRIPTION OF PROPERTY
THE BLUFF AT ARLINGTON,A CONDOMINIUM
THAT PORTION OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER OF SECTION
10,TOWNSHIP 31 NORTH,RANGE 5 EAST,W.M. IN SHOHOMISH COUNTY, WASHINGTON,
DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER OF SAID SUBDIVISION;THENCE SOUTH
3°27'54"WEST, 780.26 FEET ALONG THE EAST LINE OF SAID SUBDIVISION;THENCE NORTH
34°52'54"WEST,428.49 FEET;THENCE NORTH 54°55'06" WEST, 125.63 FEET;THENCE NORTH
12°08'26" WEST, 143.55 FEET;THENCE NORTH 23°27'48" WEST,250.80 FEET TO THE NORTH
LINE OF SAID SUBDIVISION;THENCE SOUTH 88°19'57"EAST, 525.28 FEET ALONG THE
NORTH LINE OF SAID SUBDIVISION TO THE POINT OF BEGINNING;
EXCEPT THEREFROM THAT PORTION CONVEYED TO BELMONT PACIFIC HOLDINGS,INC.,
A WASHINGTON CORPORATION,BY STATUTORY WARRANTY DEED RECORDED UNDER
RECORDING NUMBER 9701270191,DESCRIBED AS FOLLOWS:
THAT PORTION OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER OF SECTION
10,TOWNSHIP 31 NORTH,RANGE 5 EAST, W.M. IN SNOHOMISH COUNTY,WASHINGTON,
MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF THE SOUTHEAST QUARTER OF THE
SOUTHWEST QUARTER OF SECTION 10,TOWNSHIP 31 NORTH,RANGE 5 EAST,W.M. IN
SNOHOMISH COUNTY WASHINGTON;THENCE SOUTH 3°27'54" WEST ALONG THE EAST
LINE OF SAID SOUTHEAST QUARTER FOR 88.67 FEET TO A POINT ON A 146.05 FOOT RADIUS
CURVE TO THE RIGHT WITH A RADIUS POINT WHICH BEARS NORTH 56004'52"EAST;
THENCE NORTHERLY ALONG SAID CURVE FOR 94.09 FEET,MORE OR LESS, WHILE
CONSUMING A CENTRAL ANGLE OF 36054'44"TO THE NORTH LINE OF SAID SOUTHEAST
QUARTER;THENCE EASTERLY ALONG SAID NORTH LINE FOR 30 FEET TO THE POINT OF
BEGINNING.
SITUATE IN THE COUNTY OF SNOHOMISH, STATE OF WASHINGTON. (DESCRIPTION BASED
ON PACIFIC NW TITLE COMPANY,ORDER NUMBER 106834-1,DATED AUGUST 23, 2000.)
u
City of Arlington Building Dept
PUBLIC WORKS CHECKLIST
PERMIT # V ` DATE
LEGAL
Plat .bet- Tax ID#
I
NAME Q V
ADDRESS ��cL ►'�L.l `
BUILDING USE C� # of BUILDING UNITS
Existing Required Signature Date
Water Meter
Fire Hydrant
Side Sewer Permit
Monitoring Manhole
Cross-Connection Control
Sewer: Off site
On site
Water: Off site
On site
Pretreatment Discharge
Permit
Water/Sewer Fees
Date received
Date Yellow returned
Date Pink returned
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CITY OF ARLINGTON
CONSTRUCTION
PERMIT
® COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.
uLLR 2r MAIL ADDRESS CITY ZIP PHONE
�I t 77 Andxey & Olga alskov 1336 Fir Everett, YIa 98201 425-252-5092
ARCH ITLLTUTT-DESIGNER MAIL ADDRESS CITY ZIP PHONE
Jdr> m&ddtwWm & Plan� 2124 Third Ave, Suite 200 Seattle, WA 98121 8-7580
MAIL ADDRESS CITY ZIP PHONE LIC NSE,l
Tadnical Assistarre Agent: Haising Hope, Inc. 5830 Evergreen Way Everett, ink, 982M 425-347-i5% B J[SII3I028M
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/
Hugo's Heating, Inc. 5415 Happy Hollow Rd. Stamcod, M 98292 360-654--9392 HJ30SI1OOEB
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE
Wolfe PluThmg, Inc. 12924 Old axhjds1VMmroe Hwy. Snohardsh, 6A 9829D 360-568-%53 KXFEpI033CJ
CLASS Or WORK
®NLW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLI(ION ❑BUILDING RELOCATION
VALUAT ION OF WORK
s 83_Gfi z:
DE�WORK
Owwr new anstnictim of
PROPOSI U USE OF BUILDING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLUAL D1,M RIPT ION 01 PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LOr BLOCK OF See Attad-Ed 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
See AttadTei CONSTRUCTION.PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE.
SIGNATURE OF O � AUTHORIZED AGENT DATE
IOB AUURLSS
See Attad-ed X' / � > /- )
(OFFICE USE ONLY)
PLUMBING MECHANICAL
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
WATER CLOSET (TOILEI) AIR COND.UNITS -H.P. EA.
BAIFIIUB REFRIGERATION UNITS-H.P.EA.
LAVATORY (WASH BASIN) BOILERS--H.P.EA
SHOWER I GAS FIRED A.C.UNITS-TONNAGE EA.
KI ICI ILN SINK& DISP FORCED AIR SYSTEMS-B.T.0 MEA
DISHWASHER WALL HEATERS-B.T.0 M
LAUNDRY IRAY UNI1 HEATERS- B.T.U. M
CLOI IIES WASHLR EVAPORAI IVE COOLERS I
WA ER HEATER CLOTHES DRYERS
URINAL VENTILATICN FAN
DRINKING FOUN I AIN RANGE FIOOD COMMERCIAL
I'LOOR DRAIN AIR HANDLING UNIT- CPM VACUUM BREAKERS / STOVE
ROOF DRAINS - RAINLEADERS METAL FIREPLACE&CHIMNEY 'f
SINK (SERVICE - BAR,ETC.) WATER HEATER
GAS PIPING
SUBTOTAL $ SUBTOTAL !
PERMIT s PERMIT !
TOTALFEE $ TOTALFEE !
SIUL YARD L 1 BILK ST RELT SL I BA'K REAR YARD�ETBACK PLAN CHECK NUMBER PLAN CHECK FEE
G /0 FEE RECEIPT NO. /
USE / _ LOT A{LF VACANT SITE
�T [ YES ❑NO FEES VALUATION FEE 7
TYPE OF C UP CY ROUP NO.OF DWILLING UNITS PLAN CHECKING NG / 7 1/
V ON BU LDING $ V -5 L'S
SILL 01 BLLX, NO.OF 7RILS MAX.000.LOAD
'v
1 3 PLUMBING00
r FIRE SPRINKLERS REQUIRED p
(�b� G � e2 ❑YES (I NO MECHANICAL 7 y,
STATE BLDG.CODE (�
COMMENTS / ENERGY CODE SURCHARGE I ��
V PENALTY U.B.C.
R E C EMVE WATER/SEWER FEES' SEC.303(a)
JAN 14 1'002 TOTAL
PERMIT VALIDATION
9 WHEN PROPERLY VALIDATED TIN THIS SPACE)THIS IS YOUR PERMIT&RECEIPT
,-
PAID CRIr BY
cc:ASSESSOR,APPLICANT,TREASURER,BLDG. DEPT, BUILDING OFFICIAL DATE
RECORDS COPY