700063.pdfSr
"s r UILDING DEPARTMENT
B ,E,M,T APPLICATION
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ADDRESS
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CITY TH
STATJ11 1AUENSIO NUMBER Or
5XV. Co - J — /2 -L� j
Legal Description of Property (Show Below or
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NEW
ALTER
REPAIR
AppIlicant FLU
Llside Heavy Lizies
LCENSE NUMB,
ft Four copies)
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H RESIDENTIAL
I
[—�
GAS
LINE!
ElNON-RESIDMNTIAL
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
FENCE
OR FILL
( ......... x . ........ Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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I hereby acknowledge 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
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit Oita Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn.
pleted In nix months.)
'YO
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on PrIV890 Property ONLY.
Any construction on the public domain (emble sidewalkso driveways,
ntarquees, etc.) Will require Separate permission.
P(.O.f — of -,—� .r.>
IrARD SETBACK STREETS]
WWII LOT AREA
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EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........... XT.
FIRE ZONE I TYPE OF
0 YES [] NO
REMARKS
PERMIT _700063
NUMBER f
[3 YEB [3 NO
DEFICIENCY THIS PROPERTY
[] YES [3 I -to
0
Valuation Fee Receipt No.
Plan Check No ................ . ...
BUILDING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
MCCAVATION OR FILL
TOTAL AMOUNT DUE
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AT=NTION APPLICATION APPROVAL
TIUS PERMIT This application is not a permit until
AUTUORIZES
ONLY THE signed by the Building official or his Dep-
WORK NOTZD uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOR IONA
DEPARTMENT
CITY OF 2AZZ
EMONDS
PR 6-1107
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