HomeMy WebLinkAbout690296.pdfPOSTED 0.:
ON KROLL MAP N
PERMIT
690296
BUILDING DEPARTMENT
NUMBER
Applicant Fill
juB ADDRE88
PERMIT APPLICATION
Inside Heavy Lines
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I NAME (OR NAME OF BUSINESS)
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a Description of Property (Show Below or Attach Four Copies)
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STREET R/W .# ..... . FT. DEFICIENCY THIS PROPERTY
LAN ST. R/W 4ALFT. 1.je.FT.
indicated on Standard Drawing #103.
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4-- 1 METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
-31a ' 1 31,111
PERO. TEST PERMIT NUMBER rA
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REMARKS
Sewer service to be provided under L.I.D. 161.
GAS
aNEW anESIDENTIAL LINE
1 1:1 NON-RESIDENTIAL F I SIGN
0 ADD RETAINING
1:1 DEMOLISH WALL
ElALTER EXCAVATE PENCE
OR FILL ( .......... x .......... Ft.)
REPAIR PRE-MOVn swim
INSP. POOL
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PLAN CHECKEADBNO
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS I
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1
27
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Plan Check No .....................
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; 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 and state laws regu- ATMNTION
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 PER311T
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMMNT
CITY OF
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- I EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
Marquees, etc.) will require separate permlsiflon.
Valuation
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0 YES Ej NO
Fee
011-6
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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-
lmowledged in space provided.
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