690388.pdf_KROLLMAP
POSTED UN NO.:
PERMIT bVUJ88
BUILDING DEPARTMENT
Applicant FIR
I NUMBER
ADDRESS
PERMIT APPLICATION
Inside Heavy Lines JOB
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NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK I STREET
BACK
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MAILING
ADDRESII
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CITY
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N�FHONIG NUMBIM
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NAME
ADDRESS
W
CITY
TELEPHONE NUMBER
NAMM
ADDRESS
CITY
TELEPHONE NUMBER
P
STATE LICENSE NUMBER LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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GAS
NEW RESIDENTIAL LINE
NON-RESIDENTIAL SIGN
ADD RETAINING
WALL
DEMOLISH
ALTER EXCAVATE FENCE
OR FILL ( x Ft.)
.......... . ........
REPAIR PRE -MOVE swim
INSP. D POOL
NUMBER OF STOIUES
_ER OF
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DWELLING Z�D AJ r=
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UNITS
NATURE OF WORK TO BE DONE X -, '.,
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PROPOSED USE
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PLOT PLA.N (Indicate Building actoacm, abutting streets)
15,E�5 Z 47_7-,4C,/-1 E D
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I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
ized agent of the owner. 31 agree to comply with city and 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 six months.)
IIGNATURE (OW'NER OR AGENT) DATE SIGNED
IZ/ 14-A-1-1
Applicant Subject to Plan Check Fee
_jg's —Permit coven work to be done on prIvAU property ONLY.
Any construction on the public domain (carbs, sidewalks, driverwaYs,
rd"queas, etc.) will require separate pernAsslon.
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
0 YES
Cf-N'O
.4
or
Plan Check No ................
BUILDING
PLUMBING
HE, AT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0 YES
0
13 NO Z
UM�_BER
DEFICIENCY THIS PROPERTY
Valuation
BY
[J YES
Fee
Z
N
No.
I
I
TOTAL AMOUNT DUE
A=NTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a pem-dt until
AUTHORIZES
signed by tile Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
—b-I—RECTOEVS 810
DEPARTMENT
CITY OF
_/ 7
EDDIONDS
/0
PR 6-1107
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