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SIDE 1,ARD SET BACK REAR YARD
VACANT SITE
CITY T/ USE ZONE MAP NUMBER I
0 YES NO 0
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NAME BUILOINU A�� AREA ARIANCE NUMBER
Ben HOekStra- 1710 X
ADDRESS HEIGHT ALL BUILDING SETBACKS
NOTE. TO EAVE LINES
CITY TELEE ONE NUMBER
".odmonds, lVaSh. B-5683
0
NAM��
hment PermElt I PERMIT NUMBER STRISISW UkMVN CHECK
Required
YES NO
CIT TELEPHONE NUMB TER SIZE SERVICE SIZE 11 CLEARA14CE CHECKED BY
STATE LWENSE NUMBER CITY CENSE NUMBER
LOT LOCK TRACT
4 Sec. 2 7 N R14,B' Vi.-LL-
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om. S cor secelts th N 00���Ealb
line thof 1301-4B' to 3 line Oo.r
ECTION
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ob; th 98904:1152"E 140';th S 313.1
PERMIT NUMBER
h dueW iTjTT th due V _�O P PERO. �EST
ESS �h S 204.251, and L-_mSS E 20.'
U InT. in :TION wrimiST IMPROVED
ji�lvide Sal TYPE OF CONATRUL YES [j NO
20 tt.
SPECIAL :1 SPECTOR RE CUPANCY GR
C] YES KING
Q
PLAN
CHECKED BY
No. OF BLOCS. PERIBLDG.
TOTAL FEE
WORK TO BE DONIS
Construct new residence
BUILDING
VALUATION
1
2
BUILDING PERMIT
FEE
PLUMBING
PERMIT FEE
FLI NEW
E] ADD
DEMOLISH
NUMBER OF 13TORIE
3
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
-
I/A--RESIDENTIAL
El NON-RESIDENTIAL
UMBER OF 4
I NWELLING
UNITS 5
DEMOLITION
PERMIT FEE
residence 6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- NTION
formation given to correct; and that I am the owner, or the duly author- ATTE
ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
luting construction; and In doing the work authorized thereby, no person AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
APPLICATION APPROVAL
This application Is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR INSPECTION
SIGNATU (OWNER OR AGENT) JJAW� lu�� DEPARTMENT
CITY OF
ED31ONDS
LOT pLA��C & APPROVED
PR 6-1107
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DIRECT.PW§V WGNA TURE
DATE