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II ' <br />� eTeTe. <br />the F.eergreen <br />CITYO� CINSLITRUCTION <br />evereft _ ` " 20535 <br />259-8745 ���4�1n�T PERMITNO_:: <br />❑ DEMOLITION ❑ COMBINATION FA BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNE6 MAIL ADDRESS CITY ZIP PHONE <br />Renwick G. Congdon Jr. P.O. Box 1332 Mukiltuo, WA 98275 347-2412 <br />ARCHITECT OR DESIGNER <br />GENERAL CONTRACTOR <br />MAIL <br />MAIL <br />Z'P PHONE <br />PHONE LICENSE R <br />Owner <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRAC TOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />S -0- <br />DESCRIBE WORK <br />Move house to lot-- additional permits to be obtained later. <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND FYAMINED 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 <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATI CONSTRUCTION OR <br />THEP OR ANC OF ST ION. <br />IG"y^ R F CONTMCT . P H IZEO T. OR OWN GATE <br />X/ <G •' <br />LEGAL DESCRIPTION OF PROPUDY(SHOW BELOW OR ATTACH FCUR COPIES) <br />17 6 11 aK GF 1 Plat of Lowell Div A <br />LOT1 <br />J00 ADDRESS <br />4815 S 9th Ave <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A,C - A, HNDLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS - 8 T U: H P <br />SHOWER <br />~ <br />GAS FIRED AC UNITS -B.TU <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS - B 7 U M EA <br />DISHWASHER <br />WALL HEATERS -BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR, ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />T <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTAL FEE <br />FP.ONTSETBACK <br />PEARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FIVES ❑NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />07I28[P09_ 4 <br />4PM ODUAN17 <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNIT', <br />PLUMBING <br />S3S <br />SIZE Of SLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />8 SRCH 113.50 <br />FIRE SPRINKLERS REOUIRED OYES NO <br />INVESTIGATION FEE <br />Sec. 300(e) <br />STATE BUILDING SURCHARGE <br />3 <br />50 <br />STATE ENERGY SURCHARGE <br />APRICATION ACC PY <br />PLANS CHECKED BY <br />APM FOR ISSUANCE <br />BY <br />DRIVEWAY PERMIT <br />TOTAL <br />3 <br />50 <br />Pcomr Mu mennu <br />PERMIT CONTINGENT ON OBTAINING MOVING PERMIT WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />FROM TRAFFIC ENGINEERING DEPARTMENT. Foundation l_f) <br />Plans to be submitted for construction permit M <br />within 3 weeks; project to be completed within 120 days. LL-) <br />O <br />N <br />I <br />Ns� <br />W <br />ADDRESS FILE <br />