HomeMy WebLinkAbout18122 Cambridge Dr_BLD972449_2025 i
INSPECTION REPORT bl`"
Permit Nov �7 Lot # _2_LS
Address !L Z_ ?
Contractor
Owner ✓ �J,.c��
Date
❑ APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION —J—G-eRRECTION REQUESTED
❑ Corrections listed below MUST BE MADE before work can be approved.
❑ Please contact inspector.
❑ Was not able to perform inspection.
CALL 435-0724 FOR &INSPECTION - 24 hour notice required.
G
Ins Date
TYPE IFINSPECTION 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
City of Ar�_,�.nyton
NOTICE and Inspection Report
Phone#
Permit No. �-���9 Lot# / l
Date Called b�=� �� Address /�/ZG l 4jI gr_/_!e'@
Time Called 3(0 Contractor/Owner r� 1
BY r Requested by ��t
TYPE OF INSPECTION REQUESTED
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing Drywall Nailing ❑ Final
❑ Foundation ❑ Rough-in Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical ❑ Other
APPROVAL ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved.
ork listed below has been inspected and approved.
❑ L 435 724 FOR REINSPECTION—24 hour notice required.
Date
Insp r
r�l City of Arl--.�ngton
NOTICE and Inspection Report
(�qc/ Phone#
��]]
Permit No. "1� `2 Lot#
Date Called :�E t,., si� Address Z
Time Called Y�Z� Contractor/OwnerCCh ^
gy Requested by C� ►�--
TYPE OF • REQUESTED
❑ Setback ❑ Roof Diaphragm Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation ❑ Roughmin Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical ❑ Other
APPROVAL ❑ CORRECTION REQUIRED
❑ rrections 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.
Date
Inspector [ //' /
City of Arlington
NOTICE and Inspection Report
Phone
Permit No. / ` _ l Lot##Date Called Z— Address
Time Called �� Contractor/Owners
By Requested byhL���
TYPE OF • REQUESTED
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation ❑ Rough4n Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical ❑ Other
pU'APPROVAL ❑ CORRECTION REQUIRED
2'W.rk
ecti ons listed below MUST BE MADE before work can be approved.
listed below has been inspected and approved.
❑ CALL 435-0724 FOR REINSPECTION—24 hour notice required.
Date
Inspector
City of Arl=mgton
NOTICE and Inspection Report
y�'� Phone#
Permit No. CO--Itf-A`7 Lot# 4
Date Called .. Address �Qt
Time Called) !3U Contractor/Owner c►C�`_Q31 L.naas4 -
gy n j Requested by
TYPE OF • REQUESTED
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation ❑ Rough-in Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical ❑ Other
APPROVAL ❑ CORRECTION REQUIRED
❑ ections listed below MUST BE MADE before work can be approved.
Work listed below has been inspected and approved.
❑ CALL ss-ona FOR REINSPECTION—24 hour notice required.
Inspector~ /- --- Date
City of Ar___�ngton
NOTICE and Inspection Report
Phone#
Permit No. Y Lot# C
Date Called 0�^��—c1� Address / �/ /_ � /LJ. r!
Time Called 7=410 Contractor/Owner P—s i C
By n,IA. Requested by Er"Q—
TYPE
OF • REQUESTED
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation Roughin Plumbing )gj Reinspection
Shear Wall ❑ Mechanical ❑ Other
APPROVAL ❑ CORRECTION REQUIRED
❑ ections 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.
Inspector - Date /��/
City of Arington
NOTICE and Inspection Report
Phone#
Permit No. 9-7✓ Lot# Z
Date Called Su C1 Address
Time Called S /'j; Contractor/Owner �4 C.'�l S
By S Y Requested by
TYPE OF • rr
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation ❑ Rough-in Plumbing ❑ Reinspection
Shear Wall ❑ Mechanical ❑ Other
❑ APPROVAL ❑ CORRECTION REQUIRED
❑ Corrections listed below MUST BE MADE before work can be approved.
❑ Work listed below has been inspected and approved.
❑ CALL 435-0j24 FOR REINSPECTION—24 hour notice required.
l�
Insp
Date (/
r City of Ar: ngton
NOTICE and Inspection Report
r p Phone#
Pennit No. Lot#
Date Called ^11- 17'9- Address ��'�2 Art�.'•4-
Time Called Contractor/Owner
By I e Requested by
TYPE OF •
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
❑ Foundation ❑ Rough-in Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical Other �T
APPROVAL ❑ CORRECTION REQUIRED
ections listed below MUST BE MADE before work can be approved.
Work listed below has been inspected and approved.
C LL 07 a FOR REINSPECTION—24 hour notice required.
Inspect Date or 7/ /5F
' i
CPC ityof Ar jngton
NOTICE and Inspection Report
Phone#
Permit No. ! - Z Lot#
Date Called n(� Address C,�1
Time Called `T Contractor/Owner :1 /�n ,-Z�Q ,e 5
By j�_ 1 S sZ Requested by
TYPE OF • REQUESTED
❑ Setback ❑ Roof Diaphragm ❑ Insulation
❑ Plumb GW ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall Nailing ❑ Final
Foundation W k ❑ Roughin Plumbing ❑ Reinspection
❑ Shear Wall ❑ Mechanical ❑ Other
APPROVAL �QCO�RTION REQUIRED
❑ coons 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.
c / /
Inspector Date
G I T OF ARL-I-NO-rON
I ONE3TR1__1CT I ON RE:RM I T
RaRMIT NO- 2 S-7-2-4!55
Owner: J.E_SIGN DESIGN 9c,,20 EDMONDS WAY EDKONDS ,6el20-
Value of Work: $45200.00 Tax =D= ESE 4D LOT E5 Phone: 200 775-1546
be- )JO 43oo&,
Describe Work: O`ONSTRuO.` IMOMIUMENT. SIGN
Proposed Use: SIGN
Legal Description:
.Sob Address: CAMB RIDGE D=
Contractor' s Name Type Address License#
Ja E.SIGN D-S_S;t S 902: i EDMONDS WAY
TOTALS Fee
-er-mI Pee $55.0 0 �)
SIGNATURE: J�
TOTAL FEE. .... .z.. .. . . .. .. $55.01i1 1 HEREBYs y f,AT 1 AVE LSD
AND EXAMIN HIS APPLIC _i N AND
PAYMENTS...... ...... ...... $0.0 KtZW THE SAME TO BE T ROE 4ND CORK-
RECT PROVISIONS US LAWS AND
TOTAL DUE.. .. . ...... . . .... $55.00 GRD-! AN ES G0VERN'.1N5 -HIS TYPE Or
+?Ru WI1 L BE r01MO IEDWITH=7HER
�G
DATE �t RECE
BUI_.-III -==ICIAL
FROM : J.E. SIGN DESIGN PHONE NO. : 778 9193 May. 08 1997 02:02PM P02
Citu of Arlington Fax!,76Q-435•-3906 May 8 .'97 9:42 P.0
CITY OF ARLINGrON
SIGN
PERMIT
NLcjsANttAL L� PLUMNINO to/slow PBpM1T NO-.'CONOINAtIQN � $t11LQIHl(#s rJ ..._. w_..-___-..—_ -. ----------•---
MAIL ZU i -
SIGN DrcSf�N_ .� rQl�''�N05 WAY ��Mo�'ps_._0.'?0
t•InI�Aoi�Eess `
i ilGiR,j
At �(Ai�A�DtiS
tU NI:GLWrfR R ------•- ----•
riLW AUUi4ION ALTI RATION .__ AE►Alfi IWILU1N6 HL'L(CAI ION
_-�.. ---
Y 0
K i2FGK S1m1at5�>) LTY DrcAv.�1►�� _ _.---
1
IjItf.eY CCRTIFY XA
TtlAT i 11AvE READ AND EXAMINED 1015 APPtIG1•
TION AND KNOW T{iE SAME TO 8E IR.UE AND CORRECT All.PROVI-
h► R;r KIN Ui r r N 't w uR^j[,�1t - c rlY6i——_ SIGNS OF LAWS ANO ORDSNANCES GOVERNING TIiIS TYP9C Of WORK
dill BE COMPLIED WITH WrlETI-IER SPECIFIED I IERiN OR NOT,THt
tut,�Mtut k w---------""" " GRANI ING Of A PER1+11 i DOES NOT PRESUME 10 GIVE AU1HORITY TO
ViOLAlf OR CANCEL THE PROvISIONS OF ANY OTI.IER STAGE 01t
I.00At LAW REC,UtATING CONSTRUC71ON OF DiE PERrORMAN"Of
Alt IQ NUMiIE / CUNS�AI ICON. PERMIT EXPIRES I YEAR FROM DATE Of tSSUANCE-
G� � /�$ WC,►u�T% u,N i[I►CI t10 AT A+�t�
4(N
C(4lM f j12I�C�cr �12. CpGUc-FI x y/
[ I ALTER [ REPAIR [ �
APPLICATION Is HPREB Y MADE FOR pERMISS16iq
PROJECTING [ TEMPORARY [ ] GROUND [ j ROOF [ ] WALL [ l OTHER, DESCRIBED AS
POLLOW S: .�. --- ---_...- . . _..r.�
SION of a typo similar to tl►at checked end described below, fastel�ed and
secured by approved supports, arc! it is itOreby agreed that if this applis;ation is approved the sign will
conform in every detail with the requlrerntPts of Cite Building code, Sign Cade, honing Ordinance and all
City Ordinances and StAte Law.
Sign will be: [ ] illuminated [vnon-iliuminated [ , plain wood ( j electric 11;�
I ~' face s ft 1{�
Size: Wgt _lbs length ^_.� width _ _ .. g
�►
Pace arcs: 40 sq. ft. Sign is 2-Nced: disLan^e fro'" SI, ---- �_
property line: 13 _-� W ..
Lower edgy will be feet _ inches abovo grade. Inner odge will be__„inches from the building.
Other edge wilt be , incl�ea from the building. LOWCT edge wit: be 10 feet - _ inches above the
above the building.
alley, sidewalk or private property grade, Sign will extona feet _ inches
121G1C. G:ON G12-t'-T�'
of what material will the sign be construclW? pace: �
Frame: ��'CZt�K ____ Wording of sign _
Rod am"um a►b
I � SIR' ,RtlttIISACK - R[ARYAAOf(T
o .- fr-..YTS':-- '- -•— u."-r`a�iT�1�-� ��..._ �.....�--^-« It --_. .:'—�—�'. �r�"."��
FROM : J.E. SIGN DESIGN PHONE NO. 778 9193 May. 08 1997 02:03PM P03
lot
o60
10
V O
• 7
'✓� p 10.470. sq. ft, ay
'✓• �p� SEE NOTES 5. 6 & 12
'y SHEET 2 OF 4 }c
0�
10,403, sq. ft.
SEE NOTES 5, 6, 12 & 18
SHEEY 2 017 A
r:���' ► , � fit' \ ��PS�' �*,�F,
10,401
t\��s �.�• \K t SEE NOTE
SHEE
25
p 11.925- sq. ft. 5� �•
24
11,6;6. sq- ft.
SEE NOTES 5, 6 & 17 t o'
CD. EEt2OF4 °o. y
r c,
ol
r
23 1
13,203. sq.
SEE NOTES 5. 6 17
bD SHEET 2 OF 4
I
PROM : J.E. SIGN DESIGN PHONE NO. 776 9193 May. 08 1997 02:03PM PO4
fic
lb
j
1`
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I�
mi
•�. 11l
j � 111 ,,, .• x � ,�
.,,_—_1 ^•off L�y "' `
1 v tb
A�
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� � II �
PROM J.E. SIGN DESIGN PHONE NO. 778 9193 May. 08 1997 02:04PM P06
�4
A� •
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. 1
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73
Memorandum
1,'
Q %
City of Arlington
Department of Community Development
Building Department
Date: 7 6V
P
To: 186
From: City of Arlington Building Department
Subject: Expired Building Permit
No work has commenced within 180 days of the date of the last inspection, as per UBC
Sec. 106.4.4 "Expiration".
Therefore this file is being closed as an expired permit.
Building Permit file no:
Last Inspection Date: v . C
A
L
Building Official
building\memoklosed
or approval of plans, specifications and computations shall not be When submittal document
construed to be a pern -or, or an approval o% any violation C iy require additional plan revie
of the provisions of this code or of any other ordinance of the juris- ferred submittal items as de-
diction- Permits presuming to give authority to violate or cancel tional plan review fee shall b
the provisions of this code or other ordinances of the jurisdiction 1_A.
shall not be valid.
107.4 Expiration of Plan F
The issuance of a permit-based on plans, specifications and oth- permit is issued within 180 &
er data shall not prevent the building official from there e aft r re- shall expire by limitation, tint
quiring the correction of errors in said plans, specifications and review may thereafter be retu.
other data, or from preventing building operations being carried the building official. The built
on thereunder when in violation of this code or of anv other ordi-
nances action by the applicant fora F
of this jurisdiction. quest by the applicant show
106.4.4 Expiration. Every permit issued by the building official control of the applicant have
under the provisions of this code shall•expire by limitation and be- No application shall be exten
come null and void if the building or work authorized by such per- new action on an application
mit is not commenced within 180 days from the dare of such resubmit plans and pay a nem
permit, or if the building or work authorized by such permit is sus- 107.5 Investigation Fees: V
pended or abandoned at any time after the work is commenced for I0751 Investigation. Whe
a period of 180 days. Before such work can be recommenced, a is required by this code has be
new permit shall be first obtained to do so, and the fee therefor
shall be one half the amount required for a new permit for such mg said permit, a special inve:
work, provided no changes have been made or will be made in the mit may be issued for such w
original plans and specifications for such work and provided fur- 107.5.2 Fee. An investigatic
ther that such suspension or abandonment has not exceeded one shall be collected whether or
year. In order to renew action on a permit after expiration, the per- issued. The investigation fee
mittee shall pay a new full permit fee. permit fee required by this co
Any permittee holding an unexpired permit may apply for an shall be the same as the minis
extension of the time within which work may commence under payment of such investigatio
that permit when the permittee is unable to commence work with- from compliance with all oth.
in the time required by this section for good and satisfactory sea- any Penalty prescribed by lam
sons. The building official may extend the time for action by the 107.6 Fee Ref rods. The bui
permittee for a period not exceeding 180 days on written request ing of any fee paid hereundf
by the permittee showing that circumstances beyond the control of collected.
the permittee have prevented action from being taken. No permit The building official may aL
shall be extended more than once. 80 percent of the permit fee pa_
106.45 Suspension or revocation. The building official may, der a permit issued in accorda=
in writing, suspend or revoke a permit issued under the provisions The building official may au
of this code whenever the permit is issued in error or on the basis of 80 percent of the plan review
1-4
C I -rY OF A RL- I NOTON
0ON0T RLIOT I QN F=,ERM I T
BERM I T NO- -9-7—a�4-49
Owner: .ACOavE` CONS- MER7_1--�-:= . ;-r . L".X�- .-
..sEViS
Value of Work: $117,739z 00 lax IDo 8574-000-016-0001 honee 33:5=4048
Describe Work. NEW -0NSTRU`"—:N
Proposed Use: SFR
Legal Description: S_ SEC 4Dt Ls-1- 25
Jab Address: 1812E C'AyBRIDGE DR
Contractor's Name Type Address License#
JACOBSEN CLINE: . ii e : v G 11712 "ERI'DLAN PL. eQE. rAC3DC 1 0m"
HORIZON HEATING INC. M 3601 1ciST ST. �4ORIZHI`s37Di;
PERKINS & SON P 852, NW 147TH AL PERK_1*2'00B 1
V
? P E R PM I T F E E S
Equipment and Fixtures Nusber 3 -Fee--- Total Charge
--------------------------------------- ------ ------------ f
PLUMBING FIXTURES i4 $7.00 $98.00
j FURNACE/UNIT HEATER i $13.25 $13.25
RANGE i $9.50' $9.50 ti
VENTILATION FANS 4 '$v.50 $26.00
DRYER 1 $9.50 $9.50 i
1' M-TAL FI REPLACE & CHIMNEY 1 $9.50 $9.50
WATER HEATER 1 $9.50 $9.50
GAS PIPING 1-5 OUTLETS 1 $5.00 $5.00
S U H T 0 T A L...... $180.25
i
TOTALS Fee
EquIRment $82.25
Fixture $98.00
Mech Permit $ 00
Permit Fee $881.50
Plan Fee $5,7`,96
Plumb permit $15.00
State fee $4.50
School Mitigation $941.00
SIIi1NATURE: � 1
TOTAL FEE.. .. .... . ........ $2,617.23 I HEREBY C_- I T.
Hd",;, READ
AND EXAMINED THIS APPLICATION AND
PAYMENTS. . ...... . .... $521.79 KNOW THE SAME TO BE TRUE AND COR-
RECT A L PROVISIONS OF LAWS AND
TOTAL DUE... . . . . . . . ..... . . 2,095<4 ORD A. Gy= - -HIS TYPE OF
WC4 W !_'_ 5E -ON'- 7 WIT WHETHER
�A 5 E iiL.E 1 Y`
D O IE-H;
co
LOT -25, GLEN EAGLE
C 1 T`r O F AR L l?Q GTTO W
S1J044OM151a CO.,Wk,
CO
1�
I
��
o a
all
I /
s
I s ti�
SGb,LE: )�= A0=0
Vile`='
CITY OF ARLINGTON
CONSTRUCTION
PERMIT
❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN
PERMIT NO �C.�L�•�
j OWNER
� rl ( ,� MAIL ADDRESS�n����, n` CITY zip PHONE
ARCHITECT
ue6a DESIGNER� ll)IYI MAIL ADDRESS
TTIi.,=u-*I Y {� me L_V S"fEvews `iXaS6 �35- �l�y�
CITY ZIP PHONE
r rW'titi"S • 13 13 L
GENERAL CON RA U MAIL ADDRESS
CITY ZIP PHONE LIC NSE/
� peEa 4n�1�, 1I+1-7, �, PL Ng L4(STEJSNs 6KA 33s-y�lx �+co w
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZI► PHONE LICENSE
IZlst- S•vtl LY N1060 �`6D� -3�i3c�
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/
„ htS fSnrJ %A q't 1420 P BMW IL, Inc I}� CLASS OF WORK
X%NLW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLIIION ❑BUILDING RELOCATION
Q VALUATION OF WORK �7 � C
Z f
1 l '� ( � 1
L DESCRIBE WORK J
M PRUPOSI U USE OF BUILDING
A I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
L j ll TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
J LUI BLOCK OF 1,-#'N �L� WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE
a GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO
VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
TAX ID NUMBER FROM PROPERTY TAX STATEMENT LOCAL LAW REGULATING CONSTRUCTION OFTHE PERFORMANCE OF
�-l4 - wo-- o I(p - QD CONSTRUCTION, PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE.
IOB AUURl55 SIGNATURE OF CONT OR AUTHORIZED AGENT DATE
t i41n► >2- r, /�f/ate— x ` S-of-Cl 74-
(OPPICE USE ONLY) --- -
P LUMEI N O 411CIIANICAL
NO. TYPE OF FIXTURB PER :i FIXTURES NO. TYPE OF EQUIPMENT PER :i FIXIVRPS
WATER CLOSET TOILET IRCOND.UNITS-II.P. FA 3qtAp.llrt•"
-4 2ATIITUB tEPRIGFRATION UN11S-II.P.PA ul ,Ilrt•«
VA-I'ORY ASII BASIN OILERS-II.P.EA. Igtap.Brt•"
MOWER AS PIRLTD A.C.UNITS-TONNAGE EA. T ti .114L•«
ITCIIEN SINK&DISPOSAL rORC1113 AIR SYSTEMS-H.T.U. MEA
J ISHWASHTIR INALL IIEATBRS-B.T.U. M
J AUNDRY TRAY NIT 1113-ATERS-B.T.U. M
SLOTIfES WASHER "' TVAPORATIVB COOLERS
ATER HEATER JAKORIIOOD
TIIES DRYERS
RINAL _ TILATION PAN
KINKING FOUNTAIN COMMERCIAL
'LOOR DRAIN HANDLING UNIT- CPM
ACUUM BREAKERS VE
OOF DRAINS-RAINLIADBRS 'AL FIREPLACE dr.CHIMNEY
SINK SERVICE-BAR,E'PC.) AIMR IIBATFR
lAS PIPING *(Up to S-$3.00.addnl. S35
ul ment fist mui be provldcd
SUII IOIAL SUB 1'01'Al,
PI7tM1'C PIHtMI'C
TOTALPEE _ TOTALFEE
51U��U 1�K STRLLIS�AC REAR YARD SETBACK PLAN CHECK UMBER PLAN CHECK FEE
(/F ( _ q• FEE / RECEIPT NO.
UST' /U 1 LUI AREA VACANT SITE 'G/ ` / �
e7 M'YLS �NO FEES VALUATION FEE
TYPE GI CONS, OCCU NC GR NO.OF DWELLING UNITS PUN CHECKING NG �/ , �l
' 1
ko
51lL OI B U . NO.Of STORIES MAX.UCC.LOAD BU'LDING
h/ PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES NO MECHANICAL
-COMMENTS �/� C-'r- ac✓� STATE BLDG.CODE
ENERGY CODE SURCHARGE
PENALTY U.B.C.
&6\ SEC.3031+)
777 WATER/SEWER FEES
TOTAL
° k, n ,��„ PERMIT VALIDATION
PY!IRY' WHEN PROPERLY VALIDATED TIN THIS SPACE)THIS IS YOUR PERMIT d RECEIPT
�} n PAID CRq BY
eftirn z'- '�y/ao
cc:ASSESSOR,APPLICANT,TREASURER,BLDG. DEPT, BUILDING OFFICIAL DATE
RECORDS COPY