640105.pdfI
Permit
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e
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PLAN FILE NUMBER BUILDING
licant FIR PERMIT
64 (Y 1 (35
11pavy Lines NUMBER
OB ADDRESS
d,
IBET
SIDE YARD (/
BACK
REAR YARD
E NUMBNR USE ZONE
51.7-
MAP NUM13EM
1
VA ANT SITE
1 VYIES
0 NO
BUILDING AREA
LOT AREA
VARIANCE NUMBER
I 13, 9"
I
HEIGHT
L BUILDING SETBACKS
NOTE: ATLO EAVE LINES
E NUMBO��_ REMARKS
Encroachment Permit PERMIT NUMBER STREET
Required
S
rl YE 0
E NUMBER METER SIZE SERVICE SIZE CLEARANCE CH:�ZBY
I
NSE NUMBER RE_ RKS
[3 YES
PERMIT NUMBER
W/,.5- L)
YPE OF CONSTRUCTION STREET iMPROV
ED
F fos- 0 YES No F
e
PrRIBLI30. TOTAL FEE
13UILDING
VALUATION
310 orip
1
2
BUILDING PERMIT
FEE
NUMBER OF STORIES
ErNEW
E] ADD
DEMOLISH
—
3
PLUMBING
PERMIT FEE
A4 a-V
HEAT & GAS LINE
PERMIT FEE
0"
Eb.
QALTER
RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS 5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
g6,
I - I I
I hereby acknowledge that I have read this application: that the In-
formation given is correct; and that I am the owner, or the duly author. ATTENTION APPLICATION APPROVAL
ized agent of the owner. I agree to comply with city and state laws regu- TIUS PERMIT This application is not a permit until
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec.
relating to Workmen's Compensation Insurance. WOIUJ NOTED tion, or his deputy; and fees are paid, and
receipt is aclmowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
SIG U 1WNFR,91t AGfNT) D INSPECTION SIGNATURE
r DIRECTO
DATE SIGNE DEPARTMENT
CITY OF
L—A EDIVIONDS
PLOT 'IF N cHEck & AP:P�R?VE
'0 PH 6-1107
FILE
14