660152.pdf.........
'�.BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLIC ION
N A (OR NAME OF BUSINESS)
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%I 1 0 ADDRESS
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ADDRESH,j�.
ADDRESS
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Below or iLlta
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SIGN
;NEW.
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I
ADD
DEMOLISH
El
FENCE
ALTER
ET
RESIDENTIAL
NUMBER OF
I
F-1
DWELLING
REPAIR
NON-RESIDENTIAL
UNITS
I hereby acknowledge that I have read this application; that the In-
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 stato laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Lilmit Oine Year be completed In ninety days.)
M8 ON TU (OWNE OR ENT) DAWN BIG ED
NOTE: wplicant Subject to Plats Check Fee
— This Permit covers work to be done on private Pr011ertY ONJUY-
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permianlon.
'D ON KROLL MAP NO.: IS 11.13�u
Is
PERMIT 660152
1 NUMBER
DDRESS A
�P 7i-
, , - 7
L
NE
SPECLU
0 YES
0 NO
I I VALUATION
BUILDING PERLUT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PE
5
FEE
DEMOLITION
6
PERATIT FEE
PLAN CHECK
7
FEE:
81
AMOUNT DUE
ATTENTION
THIS PER511T
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
MONDS
PR 6-1107
-7-7- 1-,% %
�TBACK YARD -'TBAC
V C SITN
[] YES 13 NO 0
VARIANCE NUMBER
61
z
0 YES [3 NO
F99
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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 aelmowledged in space provided.
DIRECTOR'S SIGNATURE
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