640426.pdfI
ing Permit
3 (OR NAME OF 151
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46— Wotv C91-149,5
cant Fill
PLAN FILE NUMBER
BUILDING
PERMIT
640426
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leavy Lines
NUMBER
JOB ADDRESS
SIDE YARD
SET BACK
REAR YARD
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2
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NUMBk;R
USE ZONE
MAP NUMBER
VACANT SITE
313Y
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0 YES T6�g:
BUILDING AABP,
IZT AREA
VARIANCE NUM7d
4�0 0 t5;" ,
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HEIGHT
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ALL BUILDING SETBACKS
TO EAVE LINES
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Permit
Required
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Q YES El NO
CITY
TELEPHONE NUMBER
METER SIZE SERVI
STATE LICENSE NUM13ER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
TYPE CONNECTION
TEST
]�ERC
FIRE ZONE TYPIS
0
SPECIAL IN E"T'R
NO
0 YES []
PLAN CHECKED BY
WORK T
E3 YES E3 NO
6
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No. OF 8LDG6.
PERIOLDG.
TOTAL FX9
!-00) 'y 7_<— 6 &wAY-1 i, V
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
145-0
NEW
0 DEMOLISH
NUMBER OF STORIES
I
3
PLUMBING
FEE
3,00
IR
DD
PERMIT
NUMBER OF
4
HEAT & GAS LINE
PERMIT FEE
ALTER
RESIDENTIAL
DWELLING
I UNITS
—
DEMOLITION
REPAIR
NON-RESIDENTIAL
5
PERMIT FEE!
PROPOSED 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-
ized agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
This application is not a permit until
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
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance.
WORK NOTED
receipt Is acknowledged in space provided.
NOTAWIRE�MIT LIMIT ONE YEAR
INSPECTION
DEPARTMENT
D NAT
ER OR
DATE
7IGNE
VCITY
OF
EDIVIONDS
Pit 6-1107
bAT
7///3
PLOT
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