660445.pdfJIM
BUILDING DEPARTMENT Applicant M11
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS
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CITY TELEPHONE NUMBI;ft
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ADDRESS
CITY TELEPHONE NUMBER
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CITY TELEPHONE NUM33ER
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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NUMBER OF STORIES
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ALTER
RESIDENTIAL
NUMBER or
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REPAIR
NON-RESIDENTIAL I
DWELLING
UNITS
I hereby acknowledgo that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state 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 Workmen's Compensation Insurance.
IE,,,,t Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIGN J��NNER 9A AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewayg,
marquees, etc.) will require separate permission.
ON KROLL MAP NO.: BUILDING
PERMIT
NUMBER 660445
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YES- ___a-r1.0 0
HEIGHT BUILDING AREA VARIANCE NUMBER
PLOT PLAN APPROV14D V4
FIRE ZONE TYPE OF CONSTRUCTION STR T IMPROVED
—27-7- M�_ �s 13 NO
SPL%7AL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES
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PLAN CHECKED BY
VALUATION
TOTAL FKK
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BUILDING
VALUATION
BUILDING PERMIT
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FEE
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PLUMBING
PERMIT FEE
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4
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
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FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
InE
8
AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a pernilt until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
WORK NOTED
tion, or his deputy; and fees are paid, and
receipt is aclmowledged In space provided.
INSPECTION
DEPARTMENT
DIRECTOR'S SIGNATURE
CITY OF
A-,
DATE
EDIVIONDS
PR 6-1101
FILE