640142.pdfI
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USE ZONE
BUILDING AREA
MAP NUMBER VACANT SITE
"S 0 NO
LOT AREA nl VARI NCE NUMBER
0
NAME
ADDRESS
5
HEIGHT
1
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
CITY
TELEPHONE NUMBER
REMARKS
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NAM
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0:
9
ADDRESS
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Encroachment Permit PERMIT NUMBER STREET GRADE CHECK16
Required
0 YES Cr-No
METER SIZE SERVICE SIZE CLEARANCE CREC
CITY
TELEPHONE NUMBER
Q
A/ /7,v
9, 623'�4
I 3�
STATE LICENSE NUMBER
CITY LICE] L
AR
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LOT BLOCK TRACT
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TYP/5 CONNYCTION VEX BY
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PERC. TEST PE7T NUMBER
N
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0) 4P je 1.2 02= j 7__'_K
0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I [] YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
eq
0 YES C] NO
1714 IWI.-V AJ 7-
PLAN CHECKED BY
WORK TO HE DONE
NO. OF SLOGS.
PERIOLD0.
TOTAL FEE
BUILDING
VALUATION
2
2
BUILDING PERMIT
FEE
NUMBER 0 F I ToRlE
aNEW
ADD
DDEMOLISH
3
3
PLUMBING'
PERMIT FEE
4
4
HEAT & GAS LINE
PERMIT FEE
ALTER
RESIDENTIAL
NUMBER OF
0
REPAIR
NON-RESIDENTIAL
DWELLING
G
UNITS
5
5
DEMOLaTION
PERMIT FEE
6
6
AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I urn the owner, or the duly author- ATTENTION
APPLICATION AP�RO'VAL
Ized agent of the owner. I agree to comply with city and state laws p regu- TIUS PERMIT
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
as
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
This application Is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt Is acknowledged in space provided.
SIGNA Ent OR AGENT) DATE 131UNhaj INSPECTION
DEPARTMENT
DIRECTOR NATURE
1: CITY OF
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1701-11eL- 40��
DAT
EDIVIONDS
,�PZT PI.I%N C#EQjt/&APPROVED
VR 6-1107
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