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BUILDING DEPARTMENT AppHeant FIR
PERMIT APPLICATION Inside Heavy Lines
1\ r1i M L J4
MAILING ADDRESS
CITY TALMPHONE NUMBER
NAME
AH ADDRESS
CITY TELEPHONE NUMBER
NAMR_—�
0
ADDIRESIq
S
Of TELEPHONE NUMBER
0 V\ VJ
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PERMIT
NUMBER
�ACK I STREET SETBACK
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STREET R/W ............ FT.
LAN ST. R/W ........... XT.
Legal Description Of rroperty (Snow j3eiow or AURCO. kour uopiea)
7- ;ZO Tfi- M; TYPE CONNECTION
_rb re-C .
e- P[Wt -T-" 6 r`Lc11'- PERO. TEST
REMARKS
FIRE ZONE TYPE OF CONB�
SPECIAn-INSPECTOR REQUIRE
GAS 0 YES M_"�
NEW RESIDENTIAL LINE PLAN CHECKEDi.,lHY
NON-REBIDENTIAL El SIGN
ADD RETAINING
DEMOLISH WALL
ElALTER EXCAVATE PENCE
OR FILL ( ........ III x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES NUM13ER OF
DWELLING
UNITS
t
N
I
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAB LINE
PENCE
SIGN
RETAINING WALL
SWIM39NO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby cLeknowledgo that I have read this application, that the In-
formation given in 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
t
in.
r.
0
0 n
a� on
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will be employed In violation of the Labor Code of the State of Washington
relating to Workmen'a Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Pleted In nix months.)
DATE SIGNED
(OWNER OR
bi.4F-T _ tGENT)
P
NOTE: Applicant Subject to Plats Check Fee
This Perrnft covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks. driveways,
nuarqu"g, etc.) will require separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 8-1107
6803
VACA14W BEEN
E3 YES )_4 0
VARIANCE/NUMBNH
DEFICIENCY THIS PROPERTY
............ PT.
Valuation
M
Z
[3 YES
Fee
I �/ -It 00 i(Will
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