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(OR NAME OF 131
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PLAN FILE NUMBER
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650300
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JOB ADDRESS 5 2-- �5 41L_�
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TELEPHONE NUMBI!;R
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MAP NUMBER
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-7
YES 13 NO
13 0
BUILDING AREA
AREA
LOT AREA
VARIANCE NUMBER
VARIANCE NXIA1134K
HEIGHT
ALL BUILDING SETBACKS
N
NOTE: TO EAVE LINES
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TELEPHONE NUMBER REMARKS
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Encroachment Permit PERMIT UMBEL% STREET GRADE CHECK
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Required
n 8 NO
YE Cl
TELEPHONE NUMBER METER SIZE
SERVICE WLE CLEARANCE CHECKED BY
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CITY LICENS19 14UM-E1% REMARKS
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[] YES [j NO
[] YES [] NO
NO. OF BLOGS.
PERIBLDG.
TOTAL 1199
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BUILDING
VALUATION
2
BUILDING PERMIT
FEE
NEW
DEMOLISH
NUMBER OF STORIES
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ADD
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3
—
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF 4
DWELLING
UNITS 5
DEMOLITION
PERMIT FEE
PROPOSED USE
0 Li
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given Is correct: and that I am the owner, or the duty author.
ATTENTION
APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu.
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen -a Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
DATE
SIG qATURE (OWNER OR AGENT) SIGNED
PLOT PLAN CHECK & APPROVED
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
MAXONDS
PH 0.1107
This application is not a permit until
Signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
,DMECYORIS N
DATE
FILE
:�.Wyullwjlnn Permit
MAIL
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-7
P:
WORK TO BE DC
TELEPHONE NUMBER
CITr LICENSE NUMBEI
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Required
[] YES
9=0
BUILDING
VALUATION
0 YES 0 No
,OT AREA VARIANCE NUNFE-ER
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
:D BY
[] YES 0 NO
BUILDING PERMIT
FEE
R NEW
D D'EMOLISH
NUMBER OF STORUIES
2
PLUMBING
ADD
3
PERMIT I= -
ALTER
RESIDENTIAL
NUMBER OF
4
HEAT & GAS LINE
PERMIT FEE
El
REPAIR
El
NON-RESIDENTIAL
DWELLING
UNITS
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
I hereby acknowledge th, I have read this application; that the In-
=3
ATTENTION
APPLICATION APPROVAL
formation give — � that I am the owner, or the duly author-
Ized agent of the-awner. -1 agree to comply with city and state laws regu.
THIS PERMIT
This application Is not a permit until
lating construction; and in doing the work at 00,1ory?y, no person
I
AUTHORIZES
will be amployed,ln-vtolation'Or -the Labor Code 0 4.
%0"teitta 6 of Washington
ONLY THE
signed by the Director of Building Inspec-
relating to Workmen's Compensation �ps.prantbj tj-ijkjr)-,Ijj9
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WORK NOTED
tion, or his deputy; and fees are paid, and
,
NOTE: PERMIT LIMIT ONE, jY
1 -4. Y-,4R
receipt is acknowled . ged in Space provided.
9IGNATURE (OWNER OR AGENT) I.PfF.-FISIGNED
INSPECTION
..,DIRECTOR'S 13IGNATURE
Z
DEPARTIAENT
CITY OF
-�PATE
�L ,
LOT PLAN CHECK.& APPROVED EDIVIONDS
el
PR 6-1107
INSPECTOR
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