640138.pdfa
FILE NUMBER
HUILDIN6
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PERMIT 64013e
Permit Application Illsldc Heavy L neB NUMBER
Building
NAME (OR NAME OF BUSINESS) JOB ADDRESS
}t C e cle
MAILING ADDRESS BIDE YARD ) T CK ) REAR YARD /
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TELEPHONE NUMMBLR USE ZONE MAP NUMBER VACANT SITE
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NUMBER
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NAME BUILDING AREA
LOT AREA (VARIANCE
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ADDRESS HEIGHT
ALL BUILDING BETBACKS
NOTE: TO EAVE LINES
CITY
TELEPHONE NUMBER REMARl{B
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ADDRESS Encroachment Permit PERM1W N R oLREEWURADE CHECK
Required
YE NO
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TELEPHONE NUMBER MESERVICE SIZE CLEARANCE JOB(.KED SY
ER
8
STATE LICENSE NUMBER
CITY LICENSE NUMBER REMARKS
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LOT BLOCK TRACT
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• TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED.
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROULTOTAL
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WORK TO BE DONE
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VALUATION
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BUILDING PERMIT ^-•
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NUMBER OF STORIES 3 FEE
NEW M DEMOLISH PLUMBING
3 PERMIT FEE
ADD
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ALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING DEMOLITION
REPAIR NON-RESIDENTIAL UNITS 0 PERMIT FEE
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PROPOSED UBE
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AMOUNT DUE
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I hereby acknowledge that I have read this application; that the to- ATTENTION
APPLICATION APPROVAL
formation given is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I 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 authorized thereby, no person AUTHORIZES
Signed by the Director Of Building IASpec-
wili be employed in violation of the Labor Code of the State of Washington ONLY THE
tion, or his deputy; ut and fees are paid, and
relating to Workmen's Compensation Insurance. {VOnK NOTED
receipt is acimowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
DIRE S IONATU1lE
III NA lUD OWN OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
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OF
05 GC a�
CITY
DATE
EDbiONDS
pytN C APPROVED
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PR 8-1107
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