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�!ir Fr,rcr��Pr. <br /> ev�rett �� NSTRUCTIOc _ <br /> PERMI 1 PERMIT N0. 13�2C� <br /> CITV HALL 259�B745 <br /> evearrr,wn9ezoi [� COM8INATION x� BUILDING GG MECHANICAL X PLUM8ING <br /> OY�HC�1 M11A!L FDDRE55 CIiY :IP PMpNE <br /> Jack D. Jurgensen 14d02 St�ne Avenue North Seattle 98020 367-563G <br /> ARGMREGT OR DESIGNER MAIL AD�RE55 CITY ZIP PMOHE <br /> GErvEPAL CONTP�GTOR MRR AD�RESS CITY '.IP PMONE LIGENSE/ <br /> Same <br /> MECMANICAL GONIqACTOF MAI�qD�RE55 CITV ZIP PNONE LIGENSE X <br /> PLOMBING CONiRRGiOP �AAIL FDOR[55 GITY ZIP PNONE lIC[NSE� <br /> CLASS OF WORK <br /> C,�j{VEW O ADDITION O ALIERFTION O REPAIR ❑ DEMOLITIpN ❑ FENCE ❑ SIGN O WOOD STOVFJFIREPLACE INSFRT <br /> vnwanor+oF woan <br /> s 35,000.00 <br /> DESCRiBE1VJRk <br /> Construct Single Family Residence <br /> PROPOSE�USE OF NUiLDIN4 Z <br /> Single Fa^.ily Residence I HENEBI' CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> �PPLICATION PND KNOW THE SAME TO BE TRUE AND �-- <br /> LEGAL OFSORIPTION OF PFOPERiY�SHOW BELOIY OR ATTACH FOUR COPIE51 C� <br /> 1 West Creek CORRECT. ALL PROVISIONS OF LAWS AND GRDINANCES r., <br /> �o�_o�ocK_oF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH ' <br /> WHFTHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> PERNIT DOES NOT PRESUME TO GIVE AUTHORffY TO VIOLATE � ��, <br /> -- OH CANCEL THE PROVISIONS OF ANY OTHEF STPTE OR ,., y <br /> LCCAL LAW REGULATING CONSTRUCTION OR THE �+ _ <br /> PE�FORMANCE OF CONSTRUCTION. o m <br /> �Go nooREss �icNnruP oF corvtnn on oq pu*NaRizEO AGENI oAIE c o <br /> 10705 :rd Avenue S.E. X m o <br /> F:UMBING MECHAN CAL � m <br /> -, z <br /> NO. TYPE OF FI%TURE OR ITEM FEF NO. TYPE OF EDUIPMENT FEE _ m'i <br /> WATEFCLOS[T�TOILEn Q 0� Alq COND. UNITS- M.P.EA. �7 <br /> BATHTU6 2 �� REFRIGEAATION UNIiS_H.P. EA. _ n � <br /> LAVATORV�IYASM BASIN) 4 OO FiOILERS - H.P.EA. r = <br /> SMOWER GAS FIflED AD.UNITS-TONNAGE EA. �N <br /> K <br /> _ � KIrCHEN SINK 8 OISP. � Q� FORCEO AIR SVSTEMS-� E.T,U. M EA. O Z <br /> 1 DISMWASHER Z OO WALL HEATERS- BS.U. M T � <br /> IAUNDflY TRAY UNIT NEATEFS- �S.U. M � m <br /> 1 CLOTME5IVASHER Z OO EVP.PORATIVE COOLERS m v, <br /> WATER HEATER Z OO 1 CIOTNES URVERS Q SO p r <br /> URINAL VENTILATION FAN n m <br /> DRINI(ING FOUNTAIN RANGE HOOD Q SO m� <br /> 1 FLOOR �PAIN 2 OO Alfl HHNDIING UNIT- C.F.M. _ � <br /> --�r <br /> VACUUM BREAKERS �TOVE - WOOD m <br /> r <br /> ROOF ORAINS- FAINLEADERS 1 METAL FIREPLACE 8 CHIMNEY ] SO � <br /> SINK�SERVICE - BAR, ETQ) FIFEVLACE INSERT � <br /> 2� <br /> HEAi PUMP D <br /> — 3' <br /> — v <br /> SUB TOTAL i 20 OO SUB TOTAL f Lb SO C <br /> PERMIT S PENMIT S � <br /> TOTAL FEE f 20 OO TOT�-.�FEE f 1( SO I'�'�'� <br /> SIDE VARD SETBACK STREET SETBACK qEAR VARG SEi�ACM. PLAN CMECK NUM6[fi� PLAN CMECK FEE <br /> Fj� 20� Z�� 84/13920 FEE140.0$ I RECEIPrNO. <br /> USE ZONE LOT AREA VACANC SiTE �-��3 <br /> R-L X$ES "NO FEES VAIUATION FEE <br /> TVPE OF CONST. OCCUPANCY GROUP N0. OF DWEI.LING UNITS <br /> V-N R-3, M 1 — �" <br /> SIZE QF� DG NO.OF STOPIES A7A%.OCC.LOA� BUILDING bjS�OOO. ZLS SG <br /> 2-3 �11�1S0 �Q. Ft. z 4 PLUMBING ?O OO <br /> M fIREZ��' F�� BASEMENT FIRE SPRINNLERS <br /> PEOUIRED MECHANICAL ZEi SO <br /> vE5 -- <br /> APPROVALS OV DATE OiHER <br /> 1. ENVIRONMENTAL GHECK LIST U B.C. <br /> PENALTV SEC.303�a; <br /> 2.BUIL�ING PLANS — <br /> 3.FIRE HYDRANT TOTAL 2S2 . OO <br /> d.FIRE PHOTECTION SVSTEM PERMIT VAlIOATION <br /> 5.GRADING WNEN PPOPCHLY VALIDATED(IN THIS SPACE)THIS IS YOI/f1 PE�RMIT-- -� `� <br /> 6.DRAINAGE � ��� <br /> Z ENVIRONMENTAL IM PACT STATEMENT � � <br /> B.HEALTH DISTHICT . , ` "� <br /> APPUCATIOY ACC.BV PLANSCMECKED BV APPfl. FOR15SUANCE 0V , ,� ` <br /> STG HWM LC <br /> :',DDRL-�S !-IIC <br />