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d�r Ecerlrren <br /> cn; u� ' sONSTR�1CTi0 �' <br /> ever�tt P�RIVIIT' PERMIT NO. �I " ' ' <br /> CITV HALL 255�H745 <br /> rveaFrT. wnsezai � COMBINATION ❑ BUILDING �I MECHANICAL ❑ PLUMBING <br /> OYJNER MqIL F�ORE55 GIiY ZIP PHO.'11 <br /> Lessley Construction <br /> ,OFCHItEGi OR OESIGNER MAIL AODRESS Gliv 21P PNONE <br /> GENEflAI CONIHACTOR IdAIL ADDPESS CITY ZIP PMONE LICENSE u <br /> IdECHANICAL CONTRAGTOR IdAIL AODPE55 LITY 21P PNONE LICENSE• <br /> Reliable Sheet bletal <br /> PWMBING CONTRACiOR MAIL qDDRESS CITY ZIP PHONE IICENSE u <br /> CLA55 OF WORK <br /> �tJEW ❑ ADOI710N ❑ ALTERATION ❑REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/I=IRGPLACE INSERT <br /> VAL04TION OF WORN <br /> 5 <br /> CESWI�E Y/OHN <br /> Gas Fm:nace <br /> PROPOSE�USE OF BULUING <br /> Single Lamily Residence I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> IEGAL OESCNPTION OF PROPERTY�SHOW BELOW OR ATTFCH POIIR COPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> LOT_BIOCK_OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHEH SPECIFIED HEHEIN OR NO7.THE GRANTING OF A <br /> PERMIT DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> __ PERFORMANCE OF CONSTRUCTION. <br /> JOB AD�RE55 SIGN�TURE OF GONTHAGTOq OR AUTHOR12E�FGENT DFiE <br /> Z2012 - 14ch Dr. S.E. X Check No. 14754 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEF. N9. TYPE OF E�UIPMENT FEE <br /> INATERCLC5E7(TOILET) AIR COND. UNITS — H.P. EA. <br /> BATHTUB REFRIGEFlATION UNITS— H.P. EA. <br /> LAVATORYQNASH BASIN) BOILERS — HP. EA. <br /> SHOWER GAS FIFED A.C. UNITS — TONNAGE EA. <br /> KITCHEN SI�IK 8 DISP. FORCED AIR SYSTEPAS— B.T.U. M EA. Z� <br /> DISHWASHEii 1NALL HEATEPS— B.T.U. M <br /> LAUNORYTfiAY UNIT NE4TER5 — B.T.U. M <br /> CLOTHESINNSHER EVAPORATIVE COOLERS <br /> WATER HEATER CLO7HE5 DRYERS <br /> URINAL VENTILATION FAN <br /> DRINF:ING FOUNTAIN RANGE HOO� <br /> FLOOR DFAIIJ AIp HANDLING UNI7 — QF.M. <br /> VACUUM BRFAKEHS STOVE —WOOD <br /> ROOF DRAIN3 — RlJNLEAOERS METAL FIREPLACE 8 CHIMNEY <br /> S:NH�SERVICE — BAR, E7C.� FIPEPLACEINSEF7 <br /> HEAT PUMP <br /> SUB TO7AL S SUB TOTAL 5 <br /> PENMIT 5 PEHMI7 5 10 00 <br /> TOTAL FEE S TOTAL FEE 5 19 50 <br /> SIOE YARD SETBACK STREE7 SETBACK REAF VARD SETBACK PLAPI CHECK NUM�ER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LUT AREA VACAN7 SITE — <br /> YES �. NO FEES VALUA710N FEE <br /> TYPE OF CONST. OCCl1PANCY GROUP NO. OF DWELLII:G UNITS <br /> BUILDING S <br /> SIZE OF BLDG. NO. OF STOHIES MA%.OCG LOAD <br /> PLUMBING <br /> FIRE ZONE BASE1dENT FIRE SPfiINKLERS MECHANICAL <br /> REOUIRE� ],¢ rj� <br /> YES NO <br /> APPROVALS BY DATE OTHEF <br /> t. E4VIRUNMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.303 lal <br /> 2.BUILDING PLANS <br /> 3.FIREHYDRANT TOTAL ]./� SO <br /> 4.FIRE PROTECTION SVS7EM PERMIT VALIOATION <br /> S.GRADING WHEN PROPERIY VALIDATED pN THIS SPACE)THIS IS YOUR PERMIT j��-- <br /> r. . 1 : I � �I ` ''1 __— r!. <br /> S.ORAINFGE • - � � <br /> 7.ENVIRONMENTALIMPACTSTATEMENT � <br /> B.HEALTH�ISTRIC7 <br /> APP�ICA710N ACC. BY PLANS CHEr,KED BY APPR. FORISSUANCE GY . � <br /> ;�.I::j�ni�tr; i'ii! . <br />