640249.pdfPLAN FIL]
Building Perm! Applicant Fill
t Application aside IIcavy Lines
NAME (Olt LqAmm ur ouSINESS) J013 AIJM
PERMIT
NUMBER
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re y e a ;-c/.
fe, 3'
jj
MAILING AJJ�XtMiOU
SIDE YARD ET BACK
S �2
fj
7
1�101NPHOZNE BUMBER1
USE
ZONE NUMBER
CITY
I,__Z; lei x
LRPA
VACANT —SITE
0 YES 0
rADDREE:8H:::::: HEIGHT ALL BUILDING SETBACKS
LINES
NOTE: TO EAVE
CITY
0
Required
49
N "'0 0
0
Ri—ER
M CHECKI ti
j4 r Poc, I rac, hl;
ZO
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT WURBER
FIRE ZONE STRUCTION STREET IMPROVED
N
YES No
SPECIAL INSPECT R REQUIRED OCCUFX—Ntjy UROUP
0 YES NO
7
PLAN CffE—CKEDBY
Z
WORK TO 1319 DONE Not Or BLDGS* PERIMILDO. TOTAL FKK
__gU_IL
ft dJ �j I VALT 7a c)
BUILDING PE T
2 FEE
I —NUMBER OF STORIES
NEW DEMOLISH PLUMBING
3 PERMIT FEE
ADD HEAT & GAS LINE
ER F 4 PERMIT FEE
ALTER RESIDENTIAL NU LLJ 0
DX NO DEMOLITION
REPAIR NON-RESIDENTIAL UNITS
5 PERMIT FEE
I RO -OSED USE 6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION APPLICATION APPROVAL
formation given Is correct: and that I am the owner, or the duly author- t until
ized agent of the owner. I agree to comply with City and state laws regu- THIS PERMIT This application is not a perml
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
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION DIRErCTO1WVS
_Tl_ DATE SIGNED DEPARTMENT
11111 ;ij�N
CITY OF
ED51ONDS DATE
APPROVED
PP PR 6-1107 A/
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