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HomeMy WebLinkAboutPermit File 2209 Cascade Court et), ran:araax_ c-, VV �� 1, t 1 1 11 II • r• 2.z Y 0, CITY OF ANACORTES WASHINGTON ycDRs BUILDING DEPARTMENT i • CERTIFICATE OF OCCUPANCY This is to certify that the(Description of Building or Structure): New Single Family Residence Located At: 2209 Cascade Court STREET A NUMBER Owner Vintage Investments Constructed By: Owner OWNER OR CONTRACTOR Bldg. Permit#: BLD-2000-4358 Date Issued: 3-3-2000 ' Occ. Group: R3 Use Zone: R2 Has Been Inspected And Occupancy Is Hereby Authorized. This 8th Day/offf y/J//`l/uly PO 03 / PUTHOOFFICIAL SEE REVERSE SIDE FOR SPECIAL REQUIREMENTS. , ■ ■ • �\i Y o CITY OF ANACORTES WASHINGTON as-; -s BUILDING DEPARTMENT I'a �-, CERTIFICATE OF OCCUPANCY 'y� This is to certify that the(Description of Building or Structure): r, Single Family Residence t Located At: 2211 CAscade Court. y., STREET&NUMBER . Owner: Vintage Invest .fits Constructed By: tiwBer t" OWNER OR CONTRACTOR Bldg. Permit#: COM2000-0041 i, Date Issued: 7-9-01 Occ. Group: R3 Use Zone: R2 !' Has Been Inspected And Occupancy Is Hereby Authorized. • This 93rd Day of October 20 01 l > 7 1 4, A HORIZING OFFICIAL SEE REVERSE SIDE FOR SPECIAL REQUIREMENTS. L. 0 • -0 • aa51C A A 9sso N�QpL' PPOEE6510N�L C '11 U a� �aum.ITY i. CERTIFIED `t o Independent p ' aMgr '1 gale Insulation2 Conlraotor�"'EMBED insulation .v/N a MASCO Company li 11(11 P.O. Box 225 • Marysville,WA 98270 Marysville (360)659-7674•• Bellingham (360)676-9969•Seattle(206)622-5185 Tacoma(800) 657-1122 Installed Insulation Certificate \. We certify insulation material listed herein meeting applicable federal,state and local specifications has been installed at the following residence surrounding conditioned space. R FACTOR AREA TYPE INCHES/BAGS(BLOWN) 11 r 1 I I I rlf i lli1 A / III I I:ii I I I; I. II , L . i.,:. I I a 1 1 ii I lili IA)All / Ihi 1•1HIi . i' I "I ', R- Li IJ N I l b P 11 Il 0 i2 / i id3l[f261 i ii0, 1 I 1 .: 09 ' 11. A I:FuE l'..V I 0,PI.14(.I1 I Certified by ,li - 1 r ,h a l Address or Lot Number Title Office Manager I c! j I , ;1,) 1 Date Installed tO � d ,.. it ., 3 4atlit f f i} t }vii 91' f • ) 0 n COMBINATION PERMIT CITY OF ANACORTES PERMIT NO: COM2000-00113 P.O. BOX 547 APPLIED: 6/7/00 ANACORTES, WA 98221 ISSUED: 7/9/01 (360)293-1901 EXPIRES: 7/9/02 SITE ADDRESS: 2209 CASCADE COURT ASSESSOR'S PARCEL NO : 3772-255-005-0015 PROJECT DESCRIPTION: New Condo OWNER CONTRACTOR LENDER VINTAGE INVESTMENTS, INC. P.O. BOX 973 ANACORTES,WA 98221 293-2596 TYPE OF WORK: NEW AREA(SF) VALU: $150,000 FEES TYPE OF USE: MF LOT: REQUIRED SETBACKS CENSUS CATEGORY: 102 1ST FLR: 1,971 FRONT: Type By Date Receipt Amount ZONING: 2ND FLR: SIDE(1): PLCK MRD 7/9/01 0106680 $36.27 R2 BASEMENT: SIDE(2): INSP MRD 7/9/01 0106680 $50.00 OCCUPANCY GROUP: GAR/CARPORT: 518 REAR' PRMT MRD 7/9/01 0106680 $558.00 L R3 OTHER: REQUIRED PARKING PMEC MRD 7/9/01 0106680 $113.50 TYPE OF CONSTRUCTION: TOTAL: PPLM MRD 7/9/01 0106680 $118.00 5N NUMBER OF UNITS: ACCESSIBLE' STBC MRD 7/9/01 0106680 $4.50 OCCUPANT LOAD: STORIES' 1 COMPACT: SEWR MRD 7/9/01 . 0106680 $3,796.00 BUILDING HEIGHT. IMPRV SURF. IMPT MRD 7/9/01 0106680 $400.00 STRM MRD 7/9/01 0106680 $1,126.00 MechanicalEquipment Plumbing Fixtures PARK MRD 7/9/01 0106680 $615.00 Equipment Type Quantit Fixture Type Quanti Total $6,817.27 Furnace< 100k btu 1 Bath Tubs. 1 Clothes Dryers , . , . . . . 1 Clothes Washers 1 Ventilation Fans 4 Dishwashers 1 Exhaust Hoods . . . . 1 Kitchen Sinks 2 Fireplace. . . . . . . . . . . . 1 Hot Water Tanks 1 Laundry Tubs or Trays 1 Gas Outlets . ' 1 S . . 2 Shhowowee rsrs . . . . . . . . 2 Kitchen Sinks,w/Disposal 1 Water Closets(Toilets), 2 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit. Issued by Applicant or Owner's Signature 24 Hour Notice Required For All Inspections n ) COMBINATION PERMIT CITY OF ANACORTES PERMIT NO: COM2000-00041 P.O. BOX 547 APPLIED: 3/3/00 ANACORTES,WA 98221 ISSUED: 7/9/01 (360)293-1901 EXPIRES: 7/9/02 SITE ADDRESS: 2211 CASCADE COURT ASSESSOR'S PARCEL NO.: 3772-255-005-0005 PROJECT DESCRIPTION: New Condo OWNER CONTRACTOR LENDER VINTAGE INVESTMENTS, INC P O BOX 973 ANACORTES,WA 98221 293-2596 TYPE OF WORK: NEW AREA(SF) VALU: $150,000 FEES TYPE OF USE: SF LOT: REQUIRED SETBACKS CENSUS CATEGORY: 102 1ST FLR: 1,971 FRONT: Type By Date Receipt Amount ZONING: 2ND FLR: SIDE(1): 'NSF DM 7/9/01 0106680 $50.00 BASEMENT: SIDE(2): PRMT DM 7/9/01 0106680 $558.00 OCCUPANCY GROUP: GAR/CARPORT: 513 REAR: PMEC DM 7/9/01 0106680 $38.30 R3 OTHER: REQUIRED PARKING PPLM DM 7/9/01 0106680 $118.00 TYPE OF CONSTRUCTION: TOTAL: STBC DM 7/9/01 0106680 $4.50 5N NUMBER OF UNITS: ACCESSIBLE: SEWR DM 7/9/01 0106680 $3,796.00 OCCUPANT LOAD: STORIES: COMPACT: PARK DM 7/9/01 0106680 $615.00 BUILDING HEIGHT: IMPRV SURF: IMPT DM 7/9/01 0106680 $400.00 STRM DM 7/9/01 0106680 $1,126 00 MechanicalEquipment Plumbing Fixtures PLCK DM 7/9/01 0106680 $36.27 Equipment Type Quantit Fixture Type Quanti Total $6,742.07 Furnace< 1 ook btu . . . . 1 Bath Tubs , 1 Clothes Washers 1 Dishwashers . 1 Hose Bibs 2 Kitchen Sinks 1 Laundry Tubs or Trays . . . . . . . . I Lavatories 3 Showers 2 Water Closets(Toile(s) . . . . . . . 2 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit Issued by Applicant or Owner's Signature 24 Hour Notice Required For All Inspections BUILDING PERMIT C CITY OF ANACORTES PERMIT NO.: BLD2000-00167 P.O. BOX 547 APPLIED: 00-06-07 ANACORTES,WA 98221 ISSUED: 00-06-07 (360)293-1901 EXPIRES: 01-06-07 SITE ADDRESS: 2209 CASCADE COURT ASSESSOR'S PARCEL NO.: 3772-255-005-0015 PROJECT DESCRIPTION: New Condo Foundation Only OWNER CONTRACTOR VINTAGE INVESTMENTS, INC. P.O. BOX 973 ANACORTES, WA 98221 Primary Phone: Primary Phone: Phone 1: 293-2596 Phone 1: License#: TYPE OF WORK: NEW AREA VALUE: $ 5000.00 TYPE OF USE: MF LOT: sf REQUIRED SETBACKS: CENSUS CATEGORY: 1ST FLR: sf ZONING: R2 FRONT: ft 2ND FLR: sf Occupancy Groups BASEMENT: sf SIDE 1: ft GAR/CARPORT: sf SIDE 2: ft 1: R3 2: OTHER: sf REAR: ft 3: 4: REQUIRED PARKING Construction Types NUMBER OF UNITS: TOTAL: 1: 5N 2: STORIES: HANDICAPPED: 3: 4: BUILDING HEIGHT: ft COMPACT: IMPRV SURF: sf FEES NOTES: Type By Date Receipt Amount PRMT MRD 00-06-07 $50.50 STBC MRD 00-06-07 $4.50 Total: $55.00 I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all ordinances and state and federal laws regulating activities covered by thiLfl Issued by Applicant or Owner's Signature CONDITIONS OF APPROVAL: 24 Hour Notice Required For All Inspections BUILDING PERMIT CITY OF ANACORTES PERMIT NO.: BLD2000-00072 P.O. BOX 547 APPLIED: 00-03-03 ANACORTES,WA 98221 ISSUED: 00-06-07 (360)293-1901 EXPIRES: 01-06-07 SITE ADDRESS: 2211 CASCADE COURT ASSESSOR'S PARCEL NO.: 3772-255-005-0005 PROJECT DESCRIPTION: New Condo Foundation Only OWNER CONTRACTOR VINTAGE INVESTMENTS, INC P.O. BOX 973 ANACORTES, WA 98221 Primary Phone: Primary Phone: Phone 1: 293-2596 Phone 1: License#: TYPE OF WORK: NEW AREA VALUE: $ 5000.00 TYPE OF USE: SF LOT: sf REQUIRED SETBACKS: CENSUS CATEGORY: 1ST FLR: sf ZONING: FRONT: ft 2ND FLR: sf SIDE 1: ft Occupancy Groups BASEMENT: sf SIDE 2: ft 1: R3 2: GAR/CARPORT: sf REAR: ft 3: 4: OTHER: sf REQUIRED PARKING Construction Types NUMBER OF UNITS: TOTAL: 1: 5N 2: STORIES: HANDICAPPED: 3: 4: BUILDING HEIGHT: ft COMPACT: IMPRV SURF: sf FEES NOTES: Type By Date Receipt Amount PRMT MRD 00-06-07 $50.50 STBC MRD 00-06-07 $4.50 Total: $55.00 I hereby acknowledge that I have read this permit and state that the above information is correct,and agree to comply with all ordinances and state and federal laws regulating activities covered by this p it. Issued by Applicant licant or Owner's Signature 9 CONDITIONS OF APPROVAL: 24 Hour Notice Required For All Inspections ye 52 3602992123 VINTAGE INVESTMENTS PAGE 11 �q �,,&y��' Q�pp :n �+ w ' X I a s,`e.44.! .?: i 're? V ' i S,K 0 s ,C it� o: v. �" 4 t- i k {t ggg N d OM _ y�i �, a��y:R SppX x e�,�'tA tl �[� {q 1' A e€ n i\` a '-",-'t✓-7 SITE ADDRESS: UPI IT C-; Lielitt"_.atz&f ASSESSOR NO.:37702-255-Ct0:.)---Ct)Q`j� LOT: / BLOCK: DIV: ADDITION: I '�_ �,uy�A r a y YY.[q yp yA .�T�. M�.vf y� 5#emn .,e,(�.�v.,a S -Swe 4 �6' �.w?�..L •' Kl� •A.. v�in • ^.Jf. 9 +.y`'..'irk,w•eFwn`S'.XulJI_ A. ... f^..p "; � � I Name: Name: Name: \;!f 1,t4 (;;Y�TMl5tirrt'IFJi :J.Pt,^, `al fL Mailing Address: MailinliAddress: Mailing Address: —Po ?Li-7 City: State: .Zip; City: State: Zip: City: Slate: Zip: Pi/tPl_L(f.]_ia: . 14j84 ligLZ( Phone No.: 1 Phone No.: Phone No.: Contractor License', VI/1fn4-/; OZ23-�j U/.f /1C.L Contact Person: 222 e-A r1toueNo.: ,293�Srtg/,✓fat- )-7&7 €e# ","Sa' "mg ,® � r'A�7�1 Ya3 " tom' Sm. a c ;' (Check One) t �, Single Family: Multi-Family: Apartment: Condominium: N Senior Housing: Retail: Office: Restaurant: Manufacturing: Storage: 13ank: _ Assembly: Accessory: Automotive Repair:[ Other(Specify): DESCRIBE OF WORK: 7wi r t4reU.4G rt ;ILO (VC'Or.; r1Zf?ri t Q 1,ti in . yS a ��. tY.. 1 q. 'Pe .q )'.Ym '{ �i gl .? q4>'• ( e . Y . f Y" C. ..! i ek , .�. e: r` I;: , s •. a a ;yiolo - ,B.• tt I t ' iiei°c�.�:.' i'� ,..i ua � a �� � �.� .i:.. .-.�'$s..�a., 'etc'.. <xa q Street Setback: ,a 1' ft. 2nd Floor sf. (Circle Y or N) 1st Side Setback: < ft. 3rd Floor: se I 2nd Side Setback: '' ft. Basement: sf. ShorclinetWetlands X C ' N Rear Setback: i (% ft. Occ. Group: Water on/Adjon/Adj., to Property C N Use Zone:_ Z • Carport Area: sf. Soils Report q) _ \ Type of Construction: itit '1521I•rit1i Garage Area: cl'%) sf. Sensitive Area y CNJ Lot Area: sr. No, of Stories: Latecomers Agreement Y (N) No.of Dwelling's: i Building Height: Z1I I •sf. rite Hydrant(250 FT) 'Si) N Lot Coverage: -Cl cli.Asea: __ sf. Variance Y 9Y) 1st Floor: icl 7 I sf. L to 77a Covenant () N Project Valuation (Labor and Material Cost): /SO 1�- 1 L.LLi4G`414-.Th-c4`-7, b � THIS APPLICATION IS RECEIVED OY TIM BUILDING OFFICIAL UNDER TILE PROVISIONS OFTIHEUNIFORM BUILDING COWL AND SHALL EXPIRE BY LRUTATI ON AND UECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN ISO DAYS OF Tt IIS APPLICATION. BY AFFIXING MY S iGNAnnui.I I1EI&GDY CERTIFY THAT l AM TIIE LEGAL OWNER oPTIIE PROPERTY FOR WII ICI ITI{IS APPLICATION IS ISSUED OR AN AUTHORIZED AG ENT OF THE OWNER. ALL PRO VISIONS OF LAWS AND ORDINANCES GOVERNING TI ITS TYPIS OF WORT:WILL DE COMPLIED WITH WIIGTHER SrrCIrrED III:RFIN OT OT.INCLUDING CALLS FOR INSPECTIONS. / /' — SIGNATURE: r�//'+ /1� r(I/iuIrC2-I . ., DATE: ` .4 --(+a `CO- i 18: 52 3602992123 VINTAGE INVESTMENTS PAGE 10 ".s sf' Mgt 2 S gC u 3 \ 30'akT+}'A$�.e• "ika r "i•"'d ter ex.Sz) i.*1. 4 SBa„ t 1 T rk i +aka N,g 3 •.0 x f v,;,l, { _l £ Y if e &� .£ �, t� si x > . + �� 4�S H..�t��•—�N� K 3.®Fn k,., � x f.. � • 3 � .��' 3<�4Rrn ,a: af.s•. ..a n,sv � ..>.rb.. a� aE w ;" kk Y M el SITE ADDRESS: V la I I i .c230(0 C�1 PA'kG4-ASSESSOR'S NO .:3 72`263 � -'ril LOT: /'S BLOCK: ADDITION: >iH " iCt ta xB>^ 1 ' 8. Itil wl ra Name: 11 C ; fy+U �1Lr//i5„ /_Jr - Name: _S/Me Mailing Address: ' '1-OF!) "2'=1Z Mailing Address: City: myAPDR7,S S State: U%/}- Zip: Crt 2. t City: State: Zip: Phone No.: C13 .?=i 1(14 Phone No.: Contractors License No.: IIme .//Oi 2.1 3 ��t�� ?".•: r) �rt l - i !J%F�i. u ..�. ?E. :e �r ,•�:fl S :Y��; ...'3''��.��.��knEy° "»fi:! NO: Time of Fixture NO: Type of.Equipment 7 Water Closet i.s GPF j. Air Cond. Unit in' Bathtub j Refrigeration Unit HP C Shower zs GPM E> Boiler ETU/HP ' Dishwasher 2.s GPM ) Forced Air System 4BTR t'l/_ =5 Lavatory as OPM (--f Floor Furnace ' Kitchen Sink 2.5 OPM ,4.. Wall Heater Clothes Washer 1 Clothes Dryer 4-) _ Urinal 1.a GPM q Ventilation Fan _ , c) Drinking Fountain ( Range Hood.. •-?) Floor Sink or Drain Air Handling Unit CFM Slop Sink r'.) Pre-Manf. Stove or Fireplace Water Piping I Gas Fireplace Hose Bibs Gas Water Heater I 1 Back Flow Prevention Device ; Gas Piping Other (Describe) Othheer.(D.escribe) `/ GAS:/ "y LLEC: OTHL-R: ` • �, .i Ti 11$APPLICATION IS RECEIVED BY THE BUILDING DEPARTMENT UNDER THE PROVISIONS OF THE UNIFORM PLUMBING AND MECHANICAL CODES AND SHALL E7a]RE BY LIMITATION AND BECOME NULL,AND VOID I'F PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF TIIIS APPLICATION. BY AFFDENG MY SIGNATURE I HEREDY CERTIFY THAT I AM TILE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT or THE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCE GOVERNING THIS TYPE OF WORK WILL DE COMPLETED WITH, WIIY'tIIER/SPECIFIED H REIN OR NOT, INCLUDING CALLS FOR INSPECTION. c7. J e ./,. 4// p f SIGNATURE: , �/; /+f �irf- �•/ .� DATE: Cg -U `Grp VINTAGE INVESTMENTS PAGE 12 < 3602992123 ixi�' � �f.t :$ �. 'p Frr�L "— sfk ,-; ' F yy Ste a"3.xx F` fm'f ar SrrE.ADDRESS:0 VIC- i rl , �_ ( 4h. i if ASSESSOR NO.J,772-X5'UQ5r-.0C05 2! 1 LOT: f� 13LOCK: DIV; ADDITION: �µ(h. _ __ .,fin` .. • �. I Name: Name: Name: l MATPlie T n1Y, � Ste. Manioc Address: jvtailinz Address: Mai inz Address: —PCB -7L12 . City: State: Zip: City; Suite: z. iD: ci State: Zit): 1 _ 4,,V Phone No.: Phone No.: Phone No.. 2 9 3 - 2 57G Contractor License:Contact Person: /211GL /:G Phone No.: cal 3261 ,Pe. . `,27G 7 11.1 c c ' .set:C'w t w'�C...AU! Z " .'AF S j+ff , t, �.�z<,o YRf.t,>„v#5. '71,, ,.` 'g,w y.A.S.,#y?+f k .. „k. 4cV; E (Check One) Single Family:cA _ Multi-Family: Apartment: Condominium: Y Senior Housing: Retail: 011ice: Restaurant: Manc$facturiag: Storage: Bank:___„_ Assembly: Accessory: Automotive Repair: Other(Specify): ((�� DESCRIBE OF WORD; (1 C1r4� r1�r M(O �? 1e .fl T72 ' tJ P i9-17a- r) t5a- r,GTa ,r,xy.'.'»,t i..Wa ,t ..Q "v v .� © .,, n"r , .,{ " i4 ;#, � �,i, g, .1/4 .FC^YX" , ,, tr 1T Fnu"� £ �nwy ,,v Z h x Street Setback: P' ft. 2nd Floor., sf. . (Circle y or N) 1st Side Setback: ft. 3rd Floor, se: ,��y 2nd Side Setback: ft. Basement sf. Shoreline/Wetlands f�/ Rear Setback i Q ft. Occ,Group: Water on/Adj. to Property Y_ N Use Zone: `R-2- • Carport Area: sf, . Soils Report ) N Typo of Construction: d)6rb R- . Garage Area: Slq sf. Sensitive Area Y 87 Lot Area: sf. No. of Stories: r Latecomers Agreement Y No. of Dwelling's:_ ) Building Heightt(a�7?o�t Li/sf. Fire Hydrant(250 FT) v �N� Cot Coverage: Peek-Ater tile sf. Variance Y IstFloor: i 07 si. Covenant 491 N Project Valuation (Labor and Material Cost): /5-O rL— CrkS G'•civ �Z7 1�i��- r, THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER The PROVISIONS 0FTI4C UNIFORM BUILDING CODE, AND SHALL EXPIRE, BY LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED Will UN ISO DAYS OF THIS APPLICATION. BY AFFIXING MY SIONATUREI HEREBY CERTIFY TIIAT I AM THE LEGAL OWNER OFTIIIS PROPERTY FOR wIBCH This APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF TIIE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING TITIS TYPE OF WORK WILL.DE COMPLIED Wrri WHETHER.SPECIFIED HEREIN 0 POT.INC GOING CALLS you INSPECTIONS. SIGNATURE: �(/! r � l „L.. _DATE: 6--69 -Ca ,t 3602992123 VINTAGE INVESTMENTS PAGE 13 �s . y_,°^•,r4 s4, i "1.1 y v,,,:s pfr,fi7 Q ..s,,, �,..!�q�p .7_k '.D 6 e 4: sx_ •a, 1 ''M a;: , ,,,..i� £ i t _: h.„ , ,4R tV`� 3 3 C3 µ y �i ds... , ;,,,,'?Ala u' El 9 0 . • u NiP atac - s (( 5p{ �. .1y I� y B '< �!M... E . . ` 9 T �t 4. � !]W �' a SS ED !> a . £S ) li � s s.. a,�}, �,x«q. �e, � .. z,, a 8:y�,>/'- cix'.,. a�,a � m. ."A.,�w •;� >�`" . ,Y � •:axnz. � S1L.�, s SITE ADDRESS: I/ /4-T - i't' N£?jL5 &OeOe ASSESSOR'S NO .: f ,577 "26b-Lp-C-OO`= LOT: /`" BLOCK: ADDITION: ,* Name: • V VA i]ACVe_. /hig$144GA I Lf'CI'�• Name: o< k1t7ti- Mailing Address:-MQT3 74` Mailing Address:_ City: Rpi E-4 State: Zip: 9Rti2.i City: State: Zip:_ Phone No.: a Q 3 " 2 5T16, 2-0r—276,9' Phone No.: Contractors License No.: lit yt r14r i (?Z z- 3 2<.„„x, M1 %�`�}�[':r}ay�rp. 7 s t� ram�. 0 �;+� 'aY a r .. R ;ftlw'.'� , F .. > •I .nY .,ea za nA � . .1. NO: Type of Fixture NO: Type of Equipment _ Water Closet I.s onn 43— Air Cond.Unit HP l Bathtub �- Refrigeration Unit BP z Shower 2.5 GPM �- Boiler BTUJHP l Dishwasher 2.SOPM {. Forced Air System BTU 7 Iu , pa� 3 Lavatory 2.5 GPM —ri— Floor Furnace . l Kitchen Sink 2.s arm Wall Heater i Clothes Washer ( Clothes Dryer Urinal I.o GPM 4 Ventilation Fart Drinking Fountain ' Range Flood Floor Sink or Drain Air Handling Unit CFM 1 Slop Sink ; e'1-' Pro-Mani. Stove or Fireplace Water Piping ' Gas Fireplace Hose Bibs 1 Gas Water Heater ff Back Flow Prevention Device ' Gas Piping Other(Describe) Othet.4Deecribe) (GAS: ELEC: OTHER: TI US APPLICATION 1S RECEIVED BT THE BUILDING DEPARTMENT UNDER THE PROVISIONS OP THE UNIFORM PLUMBING AND MECHANICAL CODES AND SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IP PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY APPIXINO MY SIGNATURE I HEREBY CERTIFY THAT I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCE GOVERNING THIS TYPE OP WOIUC WILL BE COOMMP'LErED , W • IER SPEECH ED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTION. /� stcNA1 URE: v2 e `l DATF,r CV (L —