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r <br />n o/,� ���g�v���•��-i.� <br />.���rje��dJved��iC7��'� '^,ONSiRUCTIQN �, <br />�ve�{��,ettc PERM�T pERMIT NQ. 1.�.2H2 <br />� E� aEi'r��w �9@z�+ O C�MgINATlON � BUILDIN(; � MECHANICAL � pLUMBING <br />OC/NEH MAtLADOPE55 CIIY pIP PI-09E <br />George W. Osborn 510 Madison Everett 98203 353-8498 <br />ARCHrtECTOR�[SIGN°�^. MAIIADDRE55 CIiY ZIP PHONE <br />GEIJEFPLCONTRACfOR MAILADOFE55 CItY ZIP PHONE 4CENSEx <br />MECMANICFL CONTFAGiOR MAIL AD�FESS CiTY ZIP PhONE LICENSE � <br />PLUld01NGCONiRAQOR MAILAODRESS CITY IIP PHONE LICtN5E1 <br />OF WORK <br />❑NEW �1DDITION CjALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF 1'/ORK � <br />S 1Z�OOO.00 <br />DESCRIBE WORK � <br />440 Sq. Ft. Addition to existing <br />PROPOSED USE OF p�ILDWa <br />Single Family Residence <br />LEGAL OESCRIPiION OF PtiOPEPiY �SHOLY BEIOV! OR PTTACH FOUR COPiES� <br />3 Beverly Hills Div. 5 <br />�01 BLOC�Of <br />E. 80' of W 100' of Lot 15 <br />510 Madison <br />PLUMBING <br />NO. TYPE OF FIX <br />S WATER CLOSET (TOILET) <br />BATHTU� <br />1 LAVATORY �WASH BASIN) <br />1 SHOWER <br />1 KITCHEN SINK 8 D�SP. <br />1 DISHWASHER <br />LAUNDRV TRAV <br />CLOTHES WASHER <br />IVATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />VACUUM BREAKERS <br />ROOF ORAINS - RAINLEAC <br />SINK �SERVICE - 9AR, EiC. <br />SUB <br />SIDE VARG SEiBACK STREET SETE3ACK REAR <br />6' 20' <br />UStNNt LUTAREA VACAI <br />R-1 24000 Sq. Ft ❑vEs <br />TYPE OFCONST. OCCUPANCV GROUP N0.0 <br />V-N Addition R-3 <br />SIZE OF BLDG. NO. OF STOPIES <br />Addition 440 S. Ft. 1 <br />L ENVIRONMENTALCHECKLIST <br />2. BUILDING PLANS <br />. 3. FlRE HYDRANT p <br />4. FIRE PROTECTION SYS�A <br />5. GRADING _� 0 <br />1 6. GRAINA�E� <br />� �7. ENVIfiO[JM�NTALIMPRCPSTATEMENT <br />G� 8, HEALTN'DI�TRICT � <br />� APPLICA�DN . BY . LANS CHECKED BV <br />� � <br />' `" ss� xwM <br />(� i n <br />residen <br />I HEREBY �ERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHEF SPECIFI[D <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CP.NCEL THE PRO� <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAl1NG <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIOfJ. <br />SiGNAlUREOFCONIRAGTOROHAUiHO,{R�IZEDAG,E•Ni� UPiE <br />X ��� ll� C%�?-6'�„-� � 2 �z �8 Z <br />MECHANICAL <br />FEE N0. TYPE OF E�UIPMENT <br />Z OO AIR CONU. UNITS — H.P. EA. <br />REFPIGERATION UNITS — H.P. EA <br />Z OO 6011ERS — H.P. EA. <br />GAS FIRED A C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — � T.U. M <br />WALL HEAfERS — B.i.U. M <br />UNI? HEATERS — B.T.U. M <br />STOVE <br />METAL <br />20' <br />MAX.00C.LOAD <br />PLUMBIN <br />FIRE SPRINKLERS <br />REOUIRED MECHANI <br />[iYES ' <br />BY DATE OTHER <br />PENALTY <br />TOTAL <br />APPR.FORISSUANCE BY <br />LC <br />DRYERS <br />FEE <br />82/11282 I FEE 60.13 <br />FEES VALl1ATION <br />g12,000 <br />U.B.C. <br />SEC. 303 (a) <br />RECEIPT NO. <br />60810 <br />FEE <br />92 50 <br />10 p0 <br />% 5� <br />110 �00 <br />i <br />PROPERLY VALIDATED �IN THIS SPACE) THIS IS YOUR PERMIT <br />0;63o ao92.50 �t�� � <br />` N <br />YOUR R�C[IP�i <br />: T�ii�n�s; �����,u <br />ADDRE55 FILE <br />- 2 r�; ;I2 <br />