HomeMy WebLinkAbout1054 ROBINHOOD DR_045886_2026 INSPECTION REPORT -
iiGr Permit No.: ni 5€i9L Lot #:
Address: i 06YContractor: Xg4�04�GOwner:
Date: 2-22-oS'
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: 11-2 2-•,E25___
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 N1 Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
.-, INSPECTION REPOR-
1 erm'C Y p Pit No''/�• � 7— S �j� Date: � O � � �; (�
C' �� i
Address/Lot No: I 1 i 1 1'`r fir;rl L"y
Contractor: P)a-V Vl P4 (�V C_-,_
N G.S0 Owner:
Supervisor: 1>CV1 y vL C. (.,(7,; �t -St���
Approval J Correction Required
❑ Corrections listed below MUST BE MADE before work can be approved
❑ Please contact inspector
❑ Was not able to perform inspection
Q Call 360.435.0674 for re-inspection -24-hour notice required
L
fl!G La" vG 66,
Inspector: Date:Z r"-If) -
TYPE OF INSPECTION REQUIRED
TESC STORM DRAIN ROAD/ LANDSCAPING
❑Slit Fence ❑Pipe ❑Sub-grade ❑Irrigation
❑Check Dam ❑Catch Basin(s) ❑Rock ❑Soil
❑Inlet Protection ❑Manhole(s) Curb&Gutter ❑Fertilizer
❑Temp.Sed ❑Oil Seperator(s) ❑Sidewalk ❑Bark
❑Sheeting ❑Down Spouts ❑Approach(s) ❑Plants
❑Straw ❑Trash Rack/Overflow ❑ATB ❑Trees
❑Seeding ❑Restrictor ❑Cl.B Asphalt ❑Root Barriers
❑Final ❑Level Spreader ❑Striping ❑Play Equipment
❑Treatment ❑Signing ❑Final
❑Infiltration ❑Final
INSPECTION REPORT
¢ytN G?'Q Permit No.: cKt Lot #:
Q' Address: / ® 5�( P e A,A)?-Ia
Contractor: C-37—
-ys, ,SO Owner:
IN 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: L 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&MMI
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
ot-
¢1.Zly G1'O Permit No.: n'f 5is80. Lot #:
F' Address: /05L( Q.O.>.a rttoV
Z Contractor: 6a��c-71
-ys, SO Owner:
j N G Date: O Y
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.
L_j l.C�
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:
H,_G"k
INSPECTION REPORT
¢ti1N GTO Permit No.:®Ll'-SecS6 Lot #:
Address: /0Se-1 XC41'
11 xcw /
Contractor: 711
O Owner:
IN 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:
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 Winsulation
❑ Other:
INSPECTION REPORT
ti1N GTO Permit No.:6 '�- S'3F6 Lot#:
¢ Address: /61 SS Y k--k, kt;./ 2
4'
Contractor: 7 4e-17"
IN OHO Owner: r�
Date:
❑ 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.
❑ ALL 435-06 4 F7 RE-INSPECTION - 24 hour notice required.
01
1400-1—
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:
INSPECTION REPORT
4tiIN O r0 Permit No.:�i �Z- S 5�k`l-Lot#: S®
Q Address: /1-7�-
Contractor: 41 eA
O Owner:
9`S /5_
IN G Date: 7 -_12 5�'
,A�PPROVAL ❑ 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.
//0117
Inspector: K�� Date: "
TYPE OF INSPECTION REQUESTED
❑ Under-floor C Framing ,❑,Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
2 2.z-
INSPECTION REPORT
1N G
�ti TQ Permit No.: a(I 58sto Lot #:
Q Address: in scf ,3.�. r►o bQ
`� r
Z Contractor: yo,-_
-�s, �O Owner:
LINO Date: 77-9 -0Y
❑ APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION P-CORRECTION REQUESTED
/�-Eorrections 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.
Inspecto : �/ Date: - 2��
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing a Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
Iff-Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
¢ti1N G?'O Permit No.:G`"I S��� Lot#:
Q' Address:
• •
� Z Contractor:
O Owner:
ING� Date:
❑ APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ,CORRECTION REQUESTED
b-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.
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A-7 77,L
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Inspector: 1 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:
r aq
INSPECTION REPORT
¢ti1N G?.O Permit No.: n,4 Saab Lot #:
Q Address: r o Sg 2.oa,'i m��o
� z
Contractor: �a-n►�T
O Owner:
9S ING� Date: y —
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.
i�`? -1 el L a 14 1&-L)0
Inspector: 5 � Date:
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove P�,Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
Z 5`%
INSPECTION REPORT
1;4
Permit No.: o`f 5f-S(n _ Lot #:
Address: f o Sgf f .06r•" l�O0
Contractor: _bAe-4ce-T'r4 Owner:
Date: 1 -7—oY
❑ 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:
z95
INSPECTION REPORT
4 AN G J, Permit No.: 014 SPSd Lot #: 6
Address: ! 0 5 Y iZo-t"V I�at n
Contractor:
93, ,�O Owner:
SING Date: /-1 S=o�
❑ APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION OCORRECTION 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.
C— Ile
c-L G
Inspector/ /te 67
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove X Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
INSPECTION REPORT
1;4
T Permit No.: O9' 5?9fa Lot #:Address: l OSY IZo6 1Ae/"aavContractor:Owner:
Date:
❑ APPROVAL �W, 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.
:, !� ``-A77'0 "-, P
C=,u c
Inspector:
c_ Date:
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation R( Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
fY to 5
INSPECTION REPORT
N G rO Permit No.: 04 5?8(v Lot #: G
Address: 10,5q �osctj hb
Contractor: �A-,u - 97
O Owner:
9s�j N G( Date: 5- 1 -7 - a y
APPROVAL ❑ PARTIAL APPROVAL
:1 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: 5'17_L J
TYPE OF INSPECTION REQUESTED
J 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
0 Other:
INSPECTION REPORT
P iNAiG
TPermit No.. � 5��3 Lot#:
Address: l05q 1&06/AtA0an0 PA_
Contractor: �►',t-nv�4 Owner:� Date:
Id-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.
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Inspector: L Date: 5--7` Y
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:
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INSPECTION REPORT
ZN G T permit No.: 04 5 8 8c- Lot#:
Address: f Lt +" 3 �io D�.
Z Contractor: '?."'�
ys �O Owner:
IN O Date: �-f— -�Y
.4'-kPPROVAL ❑ 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:IF =MTW
,AY "6
PE OF 146PECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
4 Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
12 I G
' INSPECTION REPORT
4ti1N G r0 Permit No.: a q 5F 94, Lot#:
Address: /0 51f
OContractor: L3,4k-�G—r-
9�, � Owner.
�IIN Date: '4—t S-o Y
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 INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
0-Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
U 1 TY UF- F4L_ I h.1GWT-[Jh1
R EL Ft M I 1-- 1-4 C7 !-:5 E3 t3 C>
Owner: BARNE:T` . DON PO BOX 93 MUKILTEU °313215
Value of Work: �138, 000. 00 Taa: ICE: 003963--000-0-,0 ;--00 Panne: 425-:346-,'5410
Describe Work: NEW SINGLE FMAILY RESIDENCE
Proposed Use: GFR
Legal Description: BURGOYNE PLAT LOT 6
Jab Address: 1054 ROBINHOOD DR
Contractor's Name Type Address, License#
LION BARNET T GEN PO BOX 93 BAI2NEB369B4
SOUTH COUNTY PLUMBING F LB 16632 79TH F°L
• W. SCiU THC,P i G;302
r-
P E R N I T F ,E; E S -
Equipment and Fixtures Number Fee Total Charge
-- --- -- - -•-- -- - -- - - - --
LUMBING FIXTURES 13 $10. 00 - ---
P` $13oi �L 0
FURNACE/UNIT NEATER 1 $.15. 00 i50�►VENTILATION FANS G $7. 00 �,$
15,. 00
URYER 00
1 $11. 00 $11. 00
METAL FIREPLACE & CHIMNEY 1 $11. 00 $11. 00
WATER HEATER 1 $15. 00 $15. 00
GAS. PIPING 1-4 OUTLETS 1 $6. 00 $6. c00
S U B T O T A L. . . . . . $230. 00
TOTALS Fee
Permit Fee $1, 370. 05
Equipment S-100. 00
Fixture $130. 00
Mech Permit $24. 00
Plan Fee S690. 53
Plumb Permit $25. 0O
State fee $4. 50
- _ . . . _ _ . . SIGNATURE_ p�u GiG rcl ,
TO`IAL FEE. . . - - - - • a2, 544. tD8 I HEREBY C;E TIFY THA� :t HAVE READ
PAYIiENTS. . . . . . . . . . . . . . . . . . 5866. 35 KAlf EXAMINED
SAMF:THIS
BPTR�EAADHCDRg
i'OTAL DUE. . . . . . - . . . . RE�,'T ALL PA0 --
OH13 C)F LAWS ANU
$1, 677. 7:3 Ui; T ANGEAll E'HI 3 'I YPE OF
1t 1 _I W WILLiPL • D WITH WHETHER
L►AT'E 1 RErE1PT # rFI UD A![7".
1NU UL
°'�Y °� RESIDL.4TIAL ADD ITI0Ni,-ALTERATION
7 z PERMIT APPLICATION
�<1NG�O Department of Community Development
City of Arlington • 238 N Olympic Ave. • Arlington, WA 98223 • Phone (360)403 3431 • FAX(360)403 3447
THIS APPLICATION TO BE USED FOR ONE AND TWO DWELLING UNITS RESIDENTIAL STRUCTURES. THIS
APPLICATION MUST BE ACCOMPANIED BY TWO(2) SETS OF CONSTRUCTION DRAWINGS, SIX(6)ACCURATE,
FULLY DIMENSIONED PLOT PLANS AND TWO(2) SETS OF ENERGY CODE APPLICATIONS.
TYPE OF PERMIT: ( ) Residential Addition ( ) Residential Alteration
( ) Plumbing ( ) Mechanical
Project Address: /C 5-v Rr_L Obi 11 or J Ott Parcel ID#: � O '� g�� �' o o e o 6 0 e3
Lot#: Subdivision:
Project Description: L4 71'Cc Ali o V 0 k " C-c-d,49- YS�i/c k
Owner: �Eoel! 4/) -k �o A "-A /�La 6.4 t.! Phone Number:
Address: /O ..Sr-cf IZ017,"A col /3& City: 4--K&y ,7_01V State: "I- Zip Code:
Contact Person: el,�A i t7 o'r -z-a het 'v",,a Phone Number: >6 0 - ele 3 -
Cell Phone: Fax: E-mail:
Address: Y 4/A 41 City: State: Zip Code:
Building Area (Sq Ft): 1st Floor: 2"d Floor: 3rd floor:
Deck: Garage/Carport: Basement:
Project Valuation:
Contractor: Phone Number:
Address: City: State: Zip Code:
Contractor's License Number: Expiration:
Plumbing Contractor- Phone Number:
Address: City State: Zip Code:
Contractor's License Number: Expiration:
Mechanical Contractor: Phone Number:
Address: City: State: Zip Code:
Contractor's License Number: Expiration:
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-
described property will be in accordanc(e�with the laws, rules and regulation of the State of Washington.
yJ� �! 14, //— �-J- o T-- �Applicants Signature Date RECEI�/�LD
6g2AL O E- IV &. a9e_�
Print Applicants Name NOV 14 2005
FOR STAFF USE ONLY COA� ng Dept_ R fGSll �r
Permit# 411- ed�BV Amount, eceived Receipt# Date Received
WEB Forms-39 Page 1 of 1 5/05 dwa
CITY OF ARLINGTON
CONSTRUCTION II
PERMIT
COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.
DWNLR MAIL ADDRESS CITY ZIP PHONE
ARCHITLCT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE
GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE Y
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I
PLUMBING CONTRACTOR / MAIL ADDRESS CITY ZIP PHONE LICENSE/
CLASS OFCLASS OF WORK
Ki NLW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑BUILDING RELOCATION
VALUATION OF WORK
ooz-
DESCRIBE WORK
PRUPOSt D USL OF BUILDING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
f C TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLGAL UESCRIPT IUN OF PRUPLRTY SHOWN BELOW OR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LUI_!_S—BLOCK • OF�Y1 � t�'I � 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 PERFORMANCE OF
CONSTRUCTION.PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE.
SIG,NATURE0F CONTRACTOR ORALIT AGENT DATE
JOB AUDRLSS
IV ;
(OFFICE USE ONLY) MECHANICAL
PLUMBING
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
j WATER CLOSEI (TOILEI) AIR COND. UNITS -H.P. EA.
'L BAIkIIUB REFRIGERATION UNITS-H.P.EA.
LAVATORY (WASH BASIN) BOILERS- H.P.EA
SHOWLR GAS FIRED A.C. UNITS-TONNAGE EA.
I KI ICHLN SINK& DISP. I FORCED AIR SYSTEMS- B T,U MEA
I DISHWASHER WALL HEATERS- B.T.0 M
LAUNDRY T RAY UNI1 HEATERS- B.T.U. M
I CLOI IJLS WASIJLR EVAPORAI IVE COOLERS
1 ER FJEATER CLOTHES DRYERS
URINAL VENTILATION FAN
7 DRINKING FOUN 1 AIN RANGE HOOD COMMERCIAL
FLUOR DRAIN AIR HANDLING UNIT- CPM
VACUUM BREAKERS I STOVE
ROOF DRAINS - RAINLEADERS METAL FIREPLACE&CHIMNEY
SINK (SERVICE - BAR,ETC.) WATER HEATER
GAS PIPING
SUBTOTAL f SUBTOTAL S
PERMIT $I PERMIT S
T TOTAL FEE f
OTALFEE $
SIDL YARD SE I BACK STRLLI SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE
2�L � FEE REC,EIP �Z
USE/UNf LOT AKkA VACANT SITE rr
6-0 0'YES ❑NO FEES VALUATION FEE
Q
TYPE OF CONST OCCUPANCY GROUP NO.OF DWELLING UNITS PLAN CHECKING NG $ 1 Q 5
N -3 14 ( BUTDING f L 370 OS
SIZL OF BLIX,. NO.Of STORIES MAX.000.LOAD � /
PLUMBING
FIRE SPRINKLERS REQUIRED
(]YES NO MECHANICAL
STATE BLDG.CODE L
COMMENTS ENERGY CODE SURCHARGE
U.B.C.
PENALTY SEC.303(a)
RECEIVED 4:bk WATERISEWER FEES
TOTAL
FEB 2 6 2004 PERMIT VALIDATION
WHEN PROPERLY VALIDATED (IN THIS SPADE)THIS IS YOUR PERMIT&RECEIPT
COLA BUILDING DEPT PAID CRli BY
cc: ASSESSOR,APPLICANT,TREASURER,BL-f�,''
I
n 0
4 N
h
�os� �•d.�+N WOo+D +`�{�- �
AR E 'T UILDERS00-1 SCALE:
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24
OJE COP RECEIVED
FEB 2 6 2004
COA BUILDING DEPT