660427.pdfW I
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POSTED ON KROLL MAP NO-: BUILDING
PERMIT
BUILDING DEPARTMENT Applicant Fill INUMBER 660427
Fill
PERMIT APPLI( Inside, 7=avyLlnes JOB ADDRESS
NAM (OR NAME OF BUSINESS) / I Z �L-
/I - SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
MAILING ADDRESS
USE ZONE
LOT AREA
VAC T 51
CITY
117N"k%1014E NUMBER
YES
74 S*,2.
HEIGHT
13UILDING AREA
VARIANGN NUMBER
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or
Lj NEW F1 I Lj SIGN
ADD "MMMA FENCE in
0 ALTER RESIDENTIAL NUMBER OF
# DWELLING
1:1 REPAIR Ni UNITS
....... S-;Z),E—N ls'A C
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
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r
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no persoj.n
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
11 ... pl Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIG?NAT RE z(;OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Sitbicct to Plan Check Fee
This remit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueest etc,) will require separate perminnim,
P
CTOR REQUIR)
C] YES
ow
ECKED BY
04
@R
STREET IMPROVED
YES
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BUILDING
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VALUATION
Z
2
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT I=
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HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERrQT
This application is not a perinit until
AUTHORIZES
signed by the Director of Building Inspee-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space provided.
INSPECTION
DEPARTMENT
DIRECTOWS SIGNATUR
CITY OF
r'"MUNDS
DATE�-
IIR 6-1101
FILE
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