670121.pdfUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION inside Heavy Lines
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PERMIT -7012.1
NUMBER 6
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TELEPHONE NUMBER
EXISTING -STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr. ............
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REMARKS
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METER SIZE SERVICE SIZE I CLEARANCE
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TELEPHONE RU�ZR
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REMARKS
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NEW
RESIDENTIAL
GAB
LINO
K71
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
OR PILL
( x I%.),
1Z
PRE -MOVE
.......... ..........
swim
REPAIR
INSP.
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
X Ajr4 At
Plan Check No .....................
BUILDING
Ja # lea A/
PLUMBING
PLOT PLAN (Indicate Building setbmcKs, abutting- streets)
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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
THIS PERMIT
relating to Workmens compensation Insurance.
AUTHOI=ES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IGN7A—TURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
C3 YES 0 NO
1 3-00 1
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE