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POSTED ON XROLL MAI' NO.:
PERMIT
BUILDING
DEPARTMENT
7
NUMBER
Appllc%=nt FlUj
PERMIT
APPLICATION
Inside Heavy Lines
J013 ADDRESS
0
E4
X4_
2
— 1.4rtl - 40-, G
SETBACK I STREET BE,
Cj
-) USE ZONE
TELEPHONE NUMBER Soo
— /I V Y,
-7 74 —1, IPO I HEIGHT
E]
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
El
PENCE
( �x Ft.)
REPAIR
PRE -MOVE
INSP.
......... . ........
swim
POOL
ZUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ 1".
FIRE ZONE I TYPE OF
SPECIAL INSPECTOR RE
(3 YES 0 NO
plan Check No .... ................
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
, 7 000442
REAR YARD b�l�
/.T- I
VACANT 91TE
[] YES [3 NO
— A I— —
DEFICIENCY THIS PROPERTY
....... .... FT.
13 YES Ij ITO
Valuation I Fee
01111111111111111!�
Z
I hereby acknowledge that I have read this application; that the In- TOTAL AMOUNT DUE
formation given to 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. ATTENTION APPLICATION APPROVAL
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 rERMIT This application is not a perntit until
relating to Workmen's Compensation InBurazet. AUTHORIZES aigned by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- Imowledged in space provided.
pleted in six months.)
INSPECTION I
HONATURE (OWNER OR AGENT DATE 81
I ;�o DEPARTMENT
CITY OF ___5A_TE
J� Ll EDDIONDS
NOTE: Applicant Subject to Plan Check Fee PU 6-1107
This permit cove" work to be done on private propertY ONLY.
Any construction on the public domain (curbs, sidewAlks, driveways,
marquees, ate.) win require separate permission.