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PLAN FILE NUMBER
5U11,L)INU
Applicant Fill
Building Permit Application lInside,
PERMIT
NUMBER 640409
Heavy Lines
NAME (OR NAME Ok- BUSINESS)
JOB ADDRESS
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REAR YARD
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MAP NUMBER
VACANT SITE
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NAME
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BUILDING AREA
LO AREA
VARIANCE NUMBEIt
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
CITY
TELEPHONE NUMBER
REMARKB
NA.ME
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Encroachment Permt-11t77-
_IPET�WIT NUMBER STREET 76R_A_DE CHECI?
Required
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f7) YES 13 NO
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CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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TYPE CONNECTION
VERIFIED BY
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0:
PERC. TEST
-
PERMIT NUMBER
I
QD
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
uYES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES [3 NO
PLAN CHECKED BY
WORK TO BE DONE
NO. Or BLOG8. PCRIOLDO. TOTAL VCR
BUILDING
1 VALUATION
BUILDING PERMIT
We
NUMBER OF STORIES
NEW DEMOLISH
2 FEE
PLUMBING
3 PERMIT FEE
ADD
RESIDENTIAL NUMBER OF
HEAT & GAS LINE
4 PERMIT FEE
ALTER
DWELLING
REPAIR NON-RESIDENTIAL UNITS
DEMOLITION
5 PFRMIT FEE
PROPOSED U13E
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-
ized agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
This application is not a perinit until
luting 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
I NOTE: PERMIT LIMIT ONE YEAR
receipt Is acknowledged In space provided.
SIGNATURE (OWNER OR AGENT)
INSPECTION
DEPARTMENT
DI1rCR1 IRE
biricial
CITY OF
DAT
MOINDS
PLOT PLAN CHECK & APPROVED
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PR 0-1107
FILE
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