670461.pdfPOSTED ON KROLL MAP NO.:
PERMIT 610461
BUILDING DEPARTMENT Applicant F111
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NUM33ER
PERMIT APPLICATION
inside Heavy Lines
JOB ADDRESS -
NAME OF BUSINESS)
NAME (OR
7-
__ I . 31]30 YARD SE7rBACX STREET SETBACK REAP. YARD SETBACK
ALAILING ADDRESS
USE ZONE LM AREA
VACAWK 131'AW
OT
TELEPHONE NUMBER
YES NO
el 11112S
7 "/" r]
HEIGHT -EU-MDING
AREA VAP61ANCM NUAIUMM
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EN38TING STREET R/W ........... FT- DEFICIENCY
��" PROPERTY
COUP. PLAN ST. R/W ............ FT.
REMARKS F4
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—314 '( 1 3
r (Show Below or Attach Four Copies) I
PERC. TEST PERMIT 17ER
If I A A ��. I I
PW
I 19=11, TYPE OF CONSTRUCTION STREET IMPROVED
1 1 13 YES [3 NO
SPECIAL INSPECTOR REWIRED
0 YES KNO
OCCUPANCY GROUP
PLAN CEMCKED BY
GAS
NEW RESIDENTIAL F LINE
NON-RESIDENTIAL SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL El ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
REMARKS
DR OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Plan Check No ............ . .......
Valuation
Fee
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BUILDING
I PLUMBING I I la. at) �0
HEAT & GAS LINE
PENCE
Cf
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have road 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-
l&tlnZ 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 WorkmeWs Compensation Insurance.
NOTE: Permit Limit Otte Your (Except DE51OLITIONS which
shoal be Completed In ninety days; MOVED -IN BUILDINGS shoal be com-
pleted in six months.)
f-
NOTE: Applicant Subject'lo Plan Check Fee
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
rumque", etc.) will require separate permission.
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
4
ATTENTION APPLICATION APPROVAL,
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or hia Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION DIREVO 8 VONAT 100
DEPARTMENT g a I NA �17
CITY OF DATE
EDMO"S q-
Pit 6-1107
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