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C t O Q `O N co Q C 13 O O N O cu b ' 0000 a O '� 0000 c r� ` `� 1 K r `-�� 1.,,� �� L J �- � �� s_ � �� ..� V .1 Coo I � �� �Jt� �.lc� Il . : —�- � -IcfN yak �l�✓� - 1.5 38 I �G�J� -I,S Fr TA*YA�2C 1. OQ�3 !� `x"S(-j I S�rE ArnR� 5 � ,-o'CN-70 e FS __-- a D v4 . d�Rh � � I 1d` Ask D&T y aso SIFT-.._ ToT /M R f,oLiS A A= 2 ►y� s� Fr DO VA 1\1 --,Pb LE S i D-A 1L-0-- REVISED �i ' i? ?01� `S,r i- -1-4'; I u� —l-A-v-e vBfe 1 uk, e u ----r� IN! ilman AI— a�I St j I s I \OPAL-1✓., —. ._ j Blh Stj r:, th 1 'I isJE ![.jd t I ,L] f.r ' e Ell E—CENED i Pr, 18 nl 1 S r ,—J - 9 2. ``Z r Cascade' � i•,i Aj r— Hosp""d ' h 4�` L-LE", +� E Highland DI BoAPERMITCENTIER ll �J ley 1� �``Y SIr� 3LE FAMILY RES" IENCE BUILDING PERMIT APPLICATION (���NG�C Department of Community Development Z.0 City of Arlington • 238 N Olympic Ave. • Arlington, WA 98223 • Phone (360)403 3431 • FAX(360) 403 3447 1 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: M Building ( ) Mechanical ( ) Plu bing ( ) Combination 10 t Project Ad r� _ e__sr), ), -� �7c*rfA `4 ez�r Parcel ID#: on q('y')SU G Lot#: Subdivision: Ci 2: C> ^ , co Project Description: r yE1,4 Owner: , Phone Number: 4 3'lcl- &5&(o Address: a©5-(,X:� ( 6 '"vim - City: State: Zip Code: Contact Person: A � �CJ11�Ir� ( Phone Number: Cell Phone: - -7r �� Fax: 3 E-mail: Address: Bmil clw h ST ' ` F City: AujoState: _IAA__ Zip Code: [Pao'3 Lending Agency: f--&r -rfi( .2. t'1,4, Phone Number: Z&A" "2 0ci Address: 5 Z� - City: State: WA _Zip Code: Ol Contractor: /�{�� �_06421 WCMA :DAL _ Phone Number. Address: 'Ck3 �� gT City: ( State: _ Zip Code Contractor's License Number: Expiration: Expiration: Plumbing Contractor T^P 7� \)VY\'�i t\�G� Phone Number: Address: yTOVA. City: e-IL)ftr4bS State: VAA Zip Code: -1 Wain Contractor's License Number: Expiration Mechanical Contract( _ ''oz J ' 1 4 1� _ Phone Number: Address: [� ���`` �o�T� 14Vh N� City: AaL)v k MKN State: Y414 Zip Code: Contractor's License Number: w� k�Z � Expiration:13 - HIU- -7zzz FOR STAFF USE ONLY C.7.7% r 'L'L2 P�cl oDO . I " I 19 I10 11 ic(o lse miTt# Accepted By Amount Received Receipt# Date Received WEB Forms-46 Page 1 of 2 5/05 dwa 07411�1 SI' 'GLE FAMILY RES 7ENCE BUILDING PERMIT APPLICATION Department of Community Development City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360)403 3431 • FAX (360)403 3447 Number of Plumbing Fixtures (Including Rough-Ins) Plumbing Fixtures Accessory Main Unit#X Total Fixture Total Number Fixtures Dwelling Unit Residence Units Multiplier Bar Sink X 1.0 = Bathtub or Combination Bath/Shower ZX 4.0 = Clotheswasher X 4.0 = Dishwasher X 1.5 = Hose Bibb X 2.5 = Kitchen Sink X 1.5 = Laundry Sink X 20 = J Lavatory(Bathroom Sink) X 1 0 = d� Shower(Stand Alone) Each Head X 20 = Water Closet(Toilet) X 2.5 = Whirlpool Bath or Combination X 40 = Bath/Shower Water Heater Total Fixture Other Units Traps (other than above items) Column Totals Estimated Project Valuation_ / - (�, � Building Square Footage a� to 15' Floor (r) 2"d Floor��� 3`d Floor r� Basement Deck _Garage L4 _ Water Supply Piping A. Fixture Units: Number of Fixtures X Fixture Units=Total Fixture Units B. Distance from meter to most remote outlet: JJ + feet. � I� C. Difference in elevation between meter and highest fixture:�f_/�� _feet above meter or feet below meter D. Pressure in street main: psi. (Measure with gauge or check with Water Department) I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described p operty will be in accordance with the laws, rules and regulation of the State of Washington _J�E Applicants Signature Dare FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received WEB Forms-46 Page 2 of 2 5/05 dwa ' c,'`� �•� City of Arlington • Public Works Utilities Division 'k,�N��O Water Department ph. 360.403.3526 CROSS CONNECTION SURVEY Residential FOR OFFICE USE ONLY Date Received: Survey reviewed by: Survey accepted by: Assembly Required: ❑ No ❑Yes DCVA RPBA Inspection Type of Residence: KSingle Family ❑ Duplex ❑ Triplex ❑ Apartment # of Units ❑ Other Project Site Address: Property Tax ID#: Lot#: \/Ct-UM V.Z. ov p 1pqs Building Permit#: Subdivision: R�4]Cwlq Building size: #of stories Project description: Ni,C\ V4('x Property Owner: -5' / ON -5-;A W\C�� Property Owner's mailing address: orlo.j C SS h '�)e Property Owner's Phone# i5 "jzAc ^ GS 2 Co Fax# Occupant/Contact's name:_ t!�\e1A m4y, zfZ Occupant/Contact's mailing Address: Occupant/Contact's Phone# J2r?'WE!Jt IrU%FAx # '-I2ZZ ,CA PERMIT CEN R The Rules and Regulations of the State of Washington Department of Health require that certain premises install backflow prevention assemblies. (WAC 246.290.490). Backflow prevention assemblies shall be installed at any premise where, in the judgement of the City of Arlington Cross Connection Control Specialist,the nature of activities on the premise may present a hazard to the public water system, should a cross connection exist. CCS Residential pg 1 2006 City of Arlington Utilities Division Cross Connection Survey Property Site Address: ` �7� f�n�y� R— V NA6\ AQI (t �-Tvf� � I A Name of person filling out survey (please print): c-k -��� Vim\ Place a check mark next to all equipment/fixtures listed below that are, or will be,permanently or occasionally connected to water for use at your residence (single family, multi-family,mobile,etc.) Toilets ❑ Shampoo Basin �L- Sinks (kitchen, bathroom, etc.) ❑ Drinking Fountains ❑ Janitor sink ❑ Film Processors Hose Bib(outside faucet) ❑ Photo Developing Sinks/Tanks etc. Bath tub ❑ Solar Heating system Shower ❑ Heating system using water Dishwasher ❑ Heating Boilers Garbage disposal ❑ Boiler Feed Lines Ice maker ❑ Bidets Clothes Washer ❑ Dialysis Equipment ❑ Air Conditioner ❑ Medical Equipment ❑ Fire Sprinkler system ❑ Water Treatment/Filtration System ,"\ Lawn Sprinkler system ❑ Decorative pond/fountain ❑ Private Well on property ❑ Hot tub ❑ Swimming pool The above information is complete and accurate to the best my knowledge. I understand that any changes in equipment connected to the domestic water system must be reported immediately to the City of Arlington Utilities Division as a condition of continued service. �4— Signature Print name l l(�,� kO o� Date CC Residential pg2 2006