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Home My WebLink About1606 W. 5th Street Address: 1606 W 5t" Street PREPARED 9/10/15, 10:16:34 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 9/10/15 -- -------- ADDRESS . : 1606 W 5TH ST SUBDIV: CONTRACTOR : PHONE OWNER CEBELAK DAVID A PHONE PARCEL 06-30-00-0-1-2805-0000- APPL NUMBER: 15-00000966 RE-ROOF ------------------------------------------------------------------------------------------------ PERMIT_ BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS --------------------- - ----------------—-—-------------------------------------------------- BL99 01 9/10/15 BLDG FINAL September 10, 2015 10:20:05 AM jlierly. Dave 775-9449 -------------- ---—----- COMMENTS AND NOTES -------------------------------------- S CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 15-00000966 Date 7/31/15 Application pin number . . . 439138 Property Address . . . . . . 1606 W STH ST ASSESSOR PARCEL NUMBER: 06-30-00-0-1-2805-0000- REPORT SALES TAX Application type description RE-ROOF Subdivision Name . . . . . . on your state excise tax forum Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 2600 (Location Code 0502) ---------------------------------------------------------------------------- Application desc TEAR OFF/INSTALL COMP --------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CEBELAK DAVID A OWNER 2027 W 6TH ST PORT ANGELES WA 983631611 ------------------------------- --------------------------------- Permit . . . . . . BUILDING - PERMIT NO PR FEE Additional desc . . TEAR OFF/INSTALL COMP Permit Fee . . . . 109.75 Plan Check Fee .00 Issue Date . . . . 7/31/15. Valuation . . . . 2600 Expiration Date 1/27/16, Qty Unit Charge Per Extension BASE FEE 95.75 1.00 14.0000 THOU BL-2001-25K (14 PER K) 14.00 ---------------------------------------------------------------------------- Other Fees . . . . . . . . STATE SURCHARGE 4.50 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 109.75 109.75 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 114.25 114.25 .00 .00 J, I 3 Separate Permits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel th provisions of a state or local law regulating constr i or the performance of � construction. 60cJ4 fate Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD - PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS-- Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-In Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar t INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit THE r ORT For City Use CITY OF ,� 1 1 Permit# /5 g(��O W A S H I N G T o N, U . S. Date Received: %- 3/ �L 321 E 5th Street Date Approved :7- -3 Port Angeles,WA 9836 P:360-417-4817 F:360-417-4711 Email:permits@citxofna.us BUILDING PERMIT APPLICATION Project Address: Q — Phone: — 3 o Primary Contact: Email: N e e Phone Property Mailing Address C �[„ Email Owner D Z 1 City � �..(� State Zip Name \ Phone Contractor AddressEmail Information city State Zip Contractor License# Exp.Date: Legal Description: Zoning: Tax Parcel# Project Value: (materials and labor) $ UO Residential ❑ Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair El Reroof(tear off/lay over) Classification For the following, fill out both pages of permit application: , (check New Construction ❑ Exterior Remodel ❑ Addition ❑ Tenant Improvement ❑ appropriate) Mechanical ❑ Plumbing ❑ Other ❑ Fire Sprinkler System Proposed rigation System Propose or Proposed Bathrooms Proposed Bedrooms , or Existing? Yes 0 No 43 1 Existing? Yes 0 No In addition to standard hard copy submittals please send a PDF copy of all Stormwater plans and Engineering to www.stormwater@cityofpa.us Project Description COD Is project in a Flood Zone: Yes 0 Noff Flood Zone Type: If in a Flood Zone, what is the value of the structure before proposed improvement? $ I have read and completed the application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required and to obtain permits prior to work. I understand that plan review fees are not refundable after review has occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is issued. I understand that if the permit is not picked up/issued within i8o days of submittal,the application will be considered abandoned and the fees will be forfeited. Date `� ` �� Print Name C� � Signature Residential Structures Existing Proposed Construction For Office Use Area Descriptions(SQ FT) Floor area Floor area $Value new area Basement First Floor Second Floor Covered Deck/Porch/Entry Deck(over 30"or i"d floor) Garage Carport Other(describe) Area Totals Commercial Structures Area Descriptions(SQ FT) Existing Proposed Construction For Office Use Floor area Floor area $Value new area Existing Structure (s) Proposed Addition Tenant Improvement? Other work(describe) Site Area Totals Lot/Site Coverage Calculations Lot Size(sq ft) Lot Coverage(sq ft)foot print of %Lot Coverage(Total lot cov_lot size) Max Bldg Height all structures sq ft :1 Site Coverage(Sq Ft of all impervious) %of Site Coverage(total site cov_lot size) Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: # Haz/Non-Haz Piping Outlets: Appliance Exhaust Fan # Heater(Suspended,Floor,Recessed wall) # Boiler/Compressor Size: # Heating/Cooling appliance # repair/alteration Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas # portable) Fireplace/Gas Stove/Gas Cook Stove/Misc. Fuel Gas Piping #of Outlets: Ventilation Fan,single duct # Furnace/Heat Pump/ Size: # Ventilation System # Forced Air Unit Plumbing Fixtures Indicate how many of each type of fixture to be installed or relocated Plumbing Traps # Water Heater # Plumbing Vent piping # Medical gas piping #of Outlets: Water Line # Fuel gas piping #of Outlets: Sewer Line. # Industrial waste pretreatment interceptor Grease Trap) Size Other(describe): T:\BUILDING\APPLICATION FORMS\Current BP Application\Building Permit 4-17-13.docx Address: 1606 W 51h Street PREPARED 9/10/15, 10:16:34 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 9/10/15 -—--------- ---------------------------------------—--=--'------------ ADDRESS . : 1606 W 5TH ST SUBDIV: CONTRACTOR : PHONE OWNER CEBELAK DAVID A PHONE PARCEL 06-30-00-0-1-2805-0000- APPL NUMBER: 15-00001060 PLUMBING PERMIT ------------------------------------------------------------------------------------------------ PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED ' ESULTS/COMMENTS --- -- — ------------ ----- PL6 01 9/10/15 R RLUMBING WATER SUPPLY------------------------------------------- A --------------- ------------------- September 10, 2015 10:18:26 AM jlierly. Dave 775-9449 PL99 01 9/10/15 JL PLUMBING FINAL September 10, 2015 10:18:50 AM jlierly. --------------------- -- ---------- COMMENTS AND NOTES ------------ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 15-00001060 Date 8/20/15 Application pin number . . . 536880 REPORT SALES TAX Property Address . . . . . . 1606 W 5TH ST ASSESSOR PARCEL NUMBER: 06-30-00-0-1-2805-0000- on your state excise tax form Application type description PLUMBING PERMIT Subdivision Name . . . . to the City of Port Angeles Property Use . (Location Code 0502) Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 250 ---------------------------------------------------------------------------- Application desc replace water supply ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CEBELAK DAVID A OWNER 2027 W 6TH ST PORT ANGELES WA 983631611 ---------------------------------=------------------------------------------ Permit . . . . . . PLUMBING PERMIT Additional desc REPLACE WATER SUPPLY Permit Fee . . . . 57.00 Plan Check Fee .00 Issue Date . . . . 8/20/15 Valuation . . . . 0 Expiration Date 2/16/16 Qty Unit Charge Per Extension BASE FEE 50.00 -- ------------------1.00 7.0000 EA-- -PL-WATER LINE -7.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- w! Permit Fee Total 57.00 57.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 57.00 57.00 .00 .00 O �V Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of Oconstruction. �5 4�rfs Ce�(4A-- QDate Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) �l T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rou h-In Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists%GirGirders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) r T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit w THE For City Use ,i CITY OFPORT NGELESF 1 _ Permit# / /b WASH I N G T O N, U . S. Date Received: 321 E 5lh Street Date Approved Port Angeles,WA 9836 P:360-417-4817 F:360-417-4711 Email:permits@cityofpa.us BUILDING PERMIT APPLICATION Project Address: ` �-�- Phone: Primary Contact u j d aloaEmail: Name Y 1 S Phone GiEJv ' T 1 Property • in d ss � r �-. � Email Owner (J— Cit Di �S Stat Name Phone Contractor Address Email Information City state zip Contractor License# Exp.Date: Legal Description: Zoning: Tax Parcel# PrIn Value: (materials and labor) $ 0 - Residential Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair VT Reroof(tear off/lay over) 13 Classification For the following,fill out both pages of permit application: (check New Construction ❑ Exte for Remodel ❑ Addition ❑ Tenant Improvement ❑ appropriate) Mechanical X Plumbing Other ❑ Fire Sprinkler System Proposed Irrigation System Proposed or Proposed Bathrooms Proposed Bedrooms . or Existing? Yes 0 No 0 Existing? Yes 0 No 0 In addition to standard hard copy submittals please send a PDF copy of all Stormwater plans and Engineering to www.stormwater(@ci1yofpa.us Project Description Is project in a Flood Zone: Yes 0 NoO Flood Zone Type: If in a Flood Zone, what is the value of the structure before proposed improvement? $ I have read and completed the application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required and to obtain permits prior to work. I understand that plan review fees are not refundable after review has occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is issued. I understand that if the permit is not picked up/issued within i8o days of submittal,the application will be considered abandoned and the fees will be forfeited. '6)aD� 15 f► S C`241::�- r Date Print Name Si ature Residential Structures ' Existing Proposed Construction For Office Use Area Descriptions(SQ.FT) Floor area Floor area $Value new area Basement First Floor Second Floor Covered Deck/Porch/Entry J, Y J' Deck(over 3o"'or i" floor), ,► F # � r Garage Carport +. - . ' Other(describe) �r Area Totals Commercial Structures Area Descriptions(SQ FT) Existing Proposed Construction For Office Use Floor area Floor area $Value new area Existing Structure (s) Proposed Addition Tenant Improvement? Other work(describe) Site Area Totals Lot/Site Coverage Calculations Lot Size(sq ft) Lot Coverage(sq ft)foot print of %Lot Coverage(Total lot cov_lot size) Max Bldg Height r all structures sq ft N 1, Site Coverage(Sq Ft of all impervious) %of Site Coverage(total site cov_lot size) Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: # Haz/Non-Haz Piping Outlets: Appliance Exhaust Fan # Heater(Suspended,Floor,Recessed wall) # Boiler/Compressor Size: # Heating/Cooling appliance i # repair/alteration Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas # portable) Fireplace/Gas Stove/Gas Cook Stove/Misc. Fuel Gas Piping #of Outlets: Ventilation Fan,single duct # Furnace/Heat Pump/ Size: # Ventilation System # Forced Air Unit Plumbing Fixtures Indicate how many of each tvpe of fixture to be installed or relocated Plumbing Traps # Water Heater # Plumbing Vent piping # Medical gas piping #of Outlets: Water Line # Fuel gas piping #of Outlets: Sewer Line # Industrial waste pretreatment interce for Grease Trap) Size Other(describe): T:\BUILDING\APPLICATION FORMS\Current BP Application\Building Permit 4-17-13.docx Address: 1606 W 5th Street PREPARED 8/28/15, 10:39:20 INSPECTION TICKET PAGE 7 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/28/15 ------------------------------------------------------------------------------------------------ ADDRESS 1606 W 5TH ST SUBDIV: CONTRACTOR DAVE'S HTG & COOLING SRVC INC PHONE (360) 452-0939 OWNER CEBELAK DAVID A PHONE PARCEL 06-30-00-0-1-2805-0000- APPL NUMBER: 15-00001024 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ---------------------------------------------------------—-----—---------—------------------ ME99 01 8/28/15L MECHANICAL FINAL August 28, 2015 10:33:39 AM jlierly. ----------------------- --- --------- COMMENTS AND NOTES -------------------------------------- % CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Va t� Application Number . . . . . 15-00001024 Date 8/13/15 Q Application pin number . . . 886400 REPORT SALES TAX Property Address . . . . . . 1606 W 5TH ST ASSESSOR PARCEL NUMBER: 06-30-00-0-1-2805-0000- on your State excise tax form Application type description RES MECHANICAL PERMIT to the City of Port Angeles Subdivision Name . . . . . . Property Use . . . . . . . . (Location Code 0502) Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 3215 ---------------------------------------------------------------------------- Application desc Ductless HP ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CEBELAK DAVID A DAVE'S HTG & COOLING SRVC INC 2027 W 6TH ST PO BOX 413 PORT ANGELES WA 983631611 PORT ANGELES WA 98362 (360) 452-0939 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc . . DUCTLESS HP Permit Fee . . . . 64.80 Plan Check Fee .00 ^ Issue Date . . . . 8/13/15 Valuation . . . . 0 Expiration Date 2/09/16 O Qty Unit Charge Per Extension BASE FEE 50.00 1.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON 14.80 ---------------------------------------------------------------------------- Special Notes and Comments Per Washington State Code 51-51-315, installation of Carbon Monoxide detector(s) is required if you are installing or replacing a fuel burning appliance (wood, pellet, gas)and must be in place prior to the final inspection of this permit. They are required to be place directly outside of each sleeping area and at least one on each floor of the house. ---------------------------------------------------------------------------- Fee summaryCharged Paid Credited Due -- ---------- ---------- Permit Fee Total 64.80 64.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.80 64.80 .00 .00 Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. f f � Date Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS-- Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-in Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b t. AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW I Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit 08/11/2015 3:09PM FAX U0001/0001 9 THE A CITY OF For City Use Permit# IS C/ Date Received: 321 East S'u Street Port Angeles,WA 98362 Date Approved P: 360-417-4817 F: 360-417-4711 permits@cityofpa.us Building Permit Application Koject Address: Main Contact: ^� Phone # r E-Mail: Property p � I Naos Q�1, phm►e , Owner MoiliugAddress Email I city scace�, - zlp^v,3� Phone Contractor avels 7 (O i Mail' &Addre Emall I ,y I City Contractor License# V .f� I KC-, Expiration: `7 + Project Value:_ Zoning: 'fax Parcel# Lot# Type of Residential Commercial ❑ Industrial ❑ Public ❑ Permit II Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ 1 For the following,fill out both pages of permit application: 2, New Construction ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑ Mechanical ❑ Plumbing 17 Other ❑ Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms Yes ❑ No ❑ ProjectTT� Description 1 have read and completed the application and know it to be true and correct 1 am authorized to apply for this permit, l understand that it is my responsibility to determine what permits are required and to obtain permits prior to working on projects. I understand that the plan review fee is not refundable after plan review has occurred. I understand that I will forfeit the review fee if 1 cancel or withdraw the application before the permit is issued. I undersUind that if the permit is not issued within 180 days of receipt,the application will be considered abandoned and the fees forfeit. Date Print Name Signature I