670170.pdfr
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside heavy ISnog
NAME (OR NAME OF BUSINESS) y
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RESIDENTIAL
NEW GAS
NON-RESIDENTIAL ❑ SIGN
a ADD RETDEMOLISHWALL
O ASDiINO.
ALTER CE
❑ ORFILL EXCAVATE ❑ (EN ..x_........ Ft. )
REPAIR ❑ IPNRE--MOVE O SWISPI L
NUMBER OF STORIES NUMBER OF
DWELLING
r UNITS %
I hereby acknowledge that I have read this appllcalion; 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 end 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.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
NOTE:
to PINn Check Fee
TWO Permkt covets
work to
be done
on private property ONLY.
Any construction on
the public
domain
(curbs, aldewaiks, driveways,
marquees,
etc.) will
require
separate permission,
EXISTING STREET R/W ..._.......FT.
COMP. PLAN ST. R/W ............FT.
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670170
DEFICIENCY TMS PROPERTY I a I '1 i -