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�, �h�'EVChveo� �-�� .-^�NSTRUCTIO��_ . - <br />e'�erett � , pERMIT �ERMir No. 16265 <br />CITV HALL 259�8745 � <br />17 —�����^�9g�°j C�S�QMIBINATION ❑ BUILDING ❑ MECHANICAL ❑ ��LUMBING <br />OWNER MAIL AO�RE55 LITY 21v PMONE <br />LESSLEY CONSTRUCTION 18204 Bothell Evt Hwv �2 Bothell WA 9�012 481-8866 <br />ARCHRECT OR UESIGNER MAIL A�ORESS dTY 21P PMONE <br />GENERPL C]NTRACTOR MAIL AOORESS CITY 21P PHONE LICENSE N <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY Z�p PMONE LICENSt r <br />PLUM6ING LONTPACTOR MAIL AODRE55 QTY ZIP PHONE LICENSE N <br />�] NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O �EMOLITION O � ENGE ❑ SIGN � WOOD STOVFJFIFEPLACE INSERT <br />.UATION OF WORN <br />S 50�0�0.00 <br />New single family residence <br />PROPoSEO USE CF BUILDING <br />Single family residence <br />LO�, <br />W�llow Creek Glen <br />1526 - 51 st PL SW <br />PLUMBING <br />NO. TYPE OF FIXTI <br />WA7ER CLOSET (TOILEn <br />BATHTUB <br />IAVATORY(WASH BASIN <br />SHOWER <br />KI7CHEN SINK 6 DISP. <br />DISHWASHER <br />LAUNDRYTFAY <br />7 CLOTfiESWASHER <br />URINAL <br />DRINKING FOUYTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />$�X 6' <br />EZONE <br />R-1 <br />PE OF CONST. <br />V-N <br />:E OF BLDG. <br />R=1415M=308 <br />SUB TOTAL S i <br />PERMIT S <br />TOTAL FEE { � <br />EET SETBACK REAR VARD < <br />20' 20' <br />AREA VACAN7 SITE <br />�.�'ES . �.NO <br />R-3 1 <br />N0. OF STOHIES MAX. OCQ LC <br />1z 5 <br />BASEMENT 'IFiE SPRINKL <br />REOUIRED <br />:�.YES -.-.NO <br />APPHOVALS BY <br />7. ENVIRONMEN7AL CHECK LIST <br />2. BUILDING PLANS — <br />3.FIREHYDRANT �� <br />4. FIRE PROTECTION SYSTHU <br />5. GRADING <br />' 6.DRAINAGE ,,_� <br />�7:ENVIRONMENTALIMPACTSTATEMENT <br />-H. HEALTH DISTRICT � <br />APPLICATION ACC. BY - PLANS CHECKED BY APP <br />� = . -� <br />c- <br />sg lc <br />.� <br />FEE <br />I HEREBY CERTIFY TIiAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMpLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCI'ION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATIIRE �k GpN17j)ICSQq pq qUTMORIZED AGENT � OAig <br />X ��( % �' - <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT <br />AI� COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P.EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — 9.T.U. M <br />�INIT Y.EATF.RS — B.7.U. M <br />FVAPOR�TIVE COOLERS <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F'.M. <br />STOVE —'NOOD <br />METAL FIREPLACE fl CHIMNEY <br />FIREPLAGEINSERT <br />HEAT PUMP <br />86/16265 <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTY <br />TOTAL <br />SUB TOTAL S <br />PEHMIT S <br />TOTAL FEE S <br />PLAN CI <br />FEEbasic <br />VALUATION <br />$ 5����0. <br />U.B.C. <br />SEC. 303 lal <br />RECEIPT NO. <br />FEE <br />283 00 <br />24 00 <br />19 50 <br />WHEN PROPERLY VALIDATED pN THI$ �P�iC�� � THIS�IS�yQ�.l� P�pMIT (_� <br />i U 1 �Il) <br />ISSUANCE BY � - � � � � ' ' � ' ' <br />, � � <br />] , .,i2 ., J <br />ADDRESS FILE <br />