640115.pdf%
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PLAN FILM NUMBER BUILDING
Applicant FIR
Building Permit Application InsIde Heavy Lines
PERMIT
INUMBER. 640115
NAME (GRNAMZ-QV-8U81NRSS)
JOB ADDRESS
C9
MAILdNG AIJI?�MbU
REAR YARD
SIDE YARD SET BACK '�A YARD
/7,
CITY TELEPHONE NUMBER
ISr
USE ZONE MAP NUMBER VAC
ky
EB 0 No
0 YES 13 NO 0
NAME
BUILDIN�A`IVWA
7TR10A
AREA
VARI NCE NUMBER
�j
7_771iu
ADDRESS
HEIGHT
ALL BUILDING SETBACKS N
I NOTE:
TO EAVE LINES
Q
CITY
TELEPHONE NUMBER
RE RKS
NAME
ADDRESS
PERMIT NUh9WR STRENr U�"�
Required bi
n- YES n NO
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE C"&RA14C r
I
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK ITRACT
TYPE-50-N—NECTION VERIFIED BY
0 rlf�
PERC. TEST PERMrr Nublislun
UG
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPAN CY GROUP
0 YES [] NO
PLAN UH—ECKED BY
0
WORK TO BE DONE
NO. OF BLUGG.
PERIBLOG.
TOTAL FEE
ft
1
BUILDING
VALUATION
2
BUILDING PERMT
FEE
FjNEW
DEMOLISH
:)F STORIE
—
PLUMBING
3
PERMIT FEE
r-7V
Ll
ADD
HEAT & GAS LINE
ALTER RESIDENTIAL
NUMBER OF
4
PERMIT FEE
DEMOLITION
DWELLING
UNITS
REPAIR NON-RESIDENTIAL
5
PERMIT FEE
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTE ION
APPLICATION APPROVAL
formation given Is correct; and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and state laws regu- TIUH PERMIT
This application is not a permit until
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
signed by the Director of Building Inspec-
will be employed in violation Of the Labor Code of the State of Washington ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance. WORK NOTED
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
-DIRECTOR'S 13IGNATURE
Bldg. Offici(ll
.—S INSPECTION
SIGNATURE (OWNkIK A Auz�A) I DATE SIGNED DEPARTMENT
Dirk van Dyk,
-�31 CITY OF
DATE
MAMNDS
PL -I- N CPIW,& APPROVED
rn 6-1107
FILE
'x
71
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