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MAILING ADDRESS IIt col-&20 BA 'IRE&R-"T Auf i
$1 E YARD $PIT K k
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TELEPHONE NUM13jut _USE �9NE NUMBER
MAP
LOT AREA
NAME �l ;BUILDING AREA,
HEIGHT
OIADDRESS
4 �;�c
NOTE
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CITY TELEPHONE NUMBER REMARKS
4
t NAM A
P; ADDRESS Encroachment Permit NUMBER STREET,- GRADE�,CHECX
PERMIT .... ..
Required
-4
YES
0
0
CITY I
SIZE CLEARANCE CHEC
TE . LEPHONE NUMBER. -METER 9x I'TERVICE . .... .
STATE LICENSE NUMBER CITY LICENSE NUMBER R
LOT BLOCK TRACT
AP ION VERIFIED -BY%
PERMIT, NUMB)CR
*-C-. TEST
F`IRE ZONE TYPE OF CONS,9ULUCTION. .18 T PROVED!;,,.
IM
SPECIAL INSPECTOR REQUIRED GROUP LJ;,V4
'C"'UP
0 YES NO
PLAN CHECK-ED BY
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WORK TO BE DONE NO. OF BLEIGS. PERIBLIDG. TdTAL'nm
Z
BUILDING
VALUATION 0d,0
BUILDING PERMIT
X rn
2 - " I U
NUMBER OF STORIES FEE Of
NEW DEMOLISH
PLUMBING
.3 PERMIT FEE �9 100 ��14
ADD I , j A , I
HEAT & GAS LINE I
ALTER F� RESIDENTIAL NUMBER OF 4 PERMIT FEE
I t5
DWELLdNG DEMOLITrON
UNITS t
REPAIR El, NON 5 PERMIT FEE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In -
ATTENTION APPLICATION APPROVAL,
formation given is correIzt: and that I am the owner, or the duly author-
Ized st�gent 'Of the owner. I agree to comply with city and state laws regu- THIS PERT�UT This apiplicatioit is not -a P*'e' r' Ink
lating co I nstr1icUi6n-.I a*ji& In doing the work authorized thereby, no person AUTHORIZES
signed by the Director of Building, InspbdIn;
ONLY THE
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are
receipt is aelmowledged In space,ptd.Wde&....�
NOTE: PERMIT LIMIT. ONE YEAR
INSPECTION
DIRECTOR'SI' SIGNATURE
DATE SIGNED
SMNATUO_T�71�1�R OR AGENT)
DEPARTMENT
CITY OF
si . - / . / , , - ,
EDAI -DATE v6r
ONDS
PLOT'PLAX CHECK & APPROVED
PR 6-1107
INSPECTOR
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