1986, 08-05 Permit: 00012461 Residence w/GarageSIGNATURE OF
OWNER OR AGENT DATE
APPLICATION
JOB ADDRESS
S ADAMS RD
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' VICTOR W
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$15.00
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PROJECT #
sOtT3814
"TEW8/05/8.)
00012461
BUILDING
$576.50
MECHANICAL
$6.58
PLUMBING
$64.00
Building Code Fee
$1.50
Energy Studies Surcharge
$15.00
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$663.50
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COUNTER ~
PLANS
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MULTIPLE PERMIT
Building Code Fee TOTAL FEE
Energy Studies Surcharge TOTAL FEE
BUILDING
Valuation: Corr 85140
* of Fl *.of Bedrooms 000
PRIMARY STRUCTURE:
Desc: DWELLING Group: R-3
g-Ft 1945 opancy Load
SECONDARY STRUCTURES:
Besc: DWELLINC2F Group: R-3
Sq-Ft 750 Occupancy Load
Desc: DWELLINGUB Group: 3
Sq-Ft 750 Occupancy Load
Desc; GARAGE Group: M-1
Sq-Ft 800 Occupancy Load
# of Rooms 080
Type: VN
Rate 32.00
Type: VN
Rate 16.00
Type: VN
Rate 6.00
Type: VN
Rate 8.00
TOTAL FEE
Permit Fee
MECHANICAL TOTAL FEE
VENT : Fan 0 Evap Cooler 0 Hood 0 Duct 0081 Misc 0 Fee
FUEL SOURCE: Electric Y Gas N Oil N Coal N Wood N Solar N
DISTRIBUTION: Forced Air Y Radiant N Heat Pomp N
PLUMBING TOTAL FEE
FIXTURES: Bar Sink 0 Drinking Fount 0 Floor Drain 01 Fee
C/W Pipe 01 Dish Washer 01 Kitchen Sink 01
Laundry Tray 01 Sewer Eject 0 Water Closet 03
Lavatory 03 Urinal 0 Shower 02
Tub 02 Bidet 0 Other 0
Garbage Disposal 0
Electric Water Heater 01 Roof Drains 0 Fee
Sewer ? N Septic/Health * 0 08_O9-~� 877�� �����0u
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OFFICE COPY
$1.50
$15.00
$576.50
576.50
$6.5
6.50
$64.00
60.00
4.00
DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signatu
Date ���
A roved
Cond.
Approval
Hold
Environmental Health Application #
Q
W. 1101 College
Room 200
Planning /Zoning
N. 721 Jefferson
Rc L.? 66' f2 (L --P t- -r,,,, d ^ t 63 • -- 9,- CE.}AsoA
Engineers
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N. 811 Jefferson ' i —. �1 - _ _ .ice __.r it
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Utilities
N. 811 Jefferson
Plan Review /Fire Prevention
N. 811 Jefferson
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Other (SEPA /Critical Material /etc.)
Fast Track /Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signatu
Date ���