660215.pdf_j1VILDING DEPARTMENT
1J:.k1,,.,d.PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
C�2 -T
SIDE YARD SETBACI
ONE
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M-TY
-ro
STATE MCENBE NUMBER
ption of Property (Show Below or
log
P,6�7:z 40 G
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0 YES
1 .11, —, 1 __7* 4V _V�_ . av Z 1, 1
0 NO
NUMBER
..EET SET
5 1ACK
.2-43 -4--
;LEAI1YitRP SETBACK
13 YES 13 NO 0
VAJtL1LNCE NUMBER I
IUCKED 33Y
DR
STREET IMPROVED
[] YES C3 NO
I
BUILDING
VALUATION
WORK TO BE DONE
:6
BUILDING PERMMT
FEE
3
PLUMBING
PERMIT FEE
4
5
t
BEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
FEE
D NEW
ADD
A
El
DEMOLISH
SIGN
FENCE
NUMBER OF STORIES
6
DEMOLITION
PERMIT FEE
0_ :
ALT4ERRESIDENTIAL
El REPAIR
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
7
PLAN CHECK
FEE
8 1 AMOUNT DUE
t' the In'
I hereby acknowledge that I have read this application; that the In-
I M aa
AT=NTION
APPLICATION APPROVAL
'by
is or the I y author
formation given is c0rr6ct; and that I am the owner, or the duly author -
formation g ven
ws regu.
of the owner. I agree to comply with city and state I a wo regu
TIUS PERBUT
This application is not a permit until
ised
th c person
lattas constmetlon; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
hington
will be employed In violation of the Labor Code of the State of Washington
' E
ONLY THE
tion, or his deputy; and fees are paid, and
Lagent
relating to Workmen's Compensation Insurance.
Ich
j
WORK NOTED
receipt is acknowledged in space provided.
sheal
1111ept. Demolitions which shall
OrMi 'Molitions wh
y days.
NOTE: Permit Limit One Your be completed in ninety days.)
D
DAT GNED
810 TURE (OWD It ORENT) DATE 01
INSPECTION
DEPARTMENT
TOR'��7a�rRE
CITY OF
CDS
TE 100V
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
_�__,;2-j
This Pernlit coven work to be done on private property ONLY.
Any construction on the public donvaln (curb*, sidewalks, driveways,
FILE
m"queelh etc.) will require separate pemission.
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