700548.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME
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MAILING ADDIIESI1
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CITY TELEPHONE NUMBER
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NAME
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ADDRESS
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NAME
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94 ADDRESS
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CITY TELEPHONE NUMBER
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STATE LICENSE NUMBER
I CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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GAS
RESIDENTIAL LINE
ElNEW
I El NON-RESIDENTIAL SIGN
Nu� � RETAINING
RDEMOLISH WALL
EXCAV'ATE FENCE
ALTER
R OR FILL E] ( x Ft.)
.......... ..........
E] REPAIR E:] PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
0 AIL5
UNITS
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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-
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-
pletcd In mix months.)
NOTE: Applicant Subject to Plats Check Fee
This Penult cuvers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sePars-te permission.
IOSTED ON KROLL MAP NO.:
PERMIT AJU040
I
NUMBER
OB ADDRESS
IIDE YARD SETBACK
STREET BET13ACK
BET;BACK
REAR YARD SETBACK
US.&�4,
A
N
LOT AREA
Z
6�:,,
No
[] YES NO
lErGHT
BUILDING AREA.
VARIANCE NUMBER
['LOT PLAN APPROVED
iWKEET R/W
EXISTING STREET R/W ............ FT!� DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/.V ............ FT. ............
REMARKS
wa
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41
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
Cd
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
M_1`EB El NO
INSPE
OCCUPANCY GROUP
[3 YES eg_o_�
PLAN CHECKED
ffY
4-16�",
Valuation I Fee
Plan Check No ..........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DMIOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a perniit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt Is ac-
WORK NOTED
Imowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATIJRE
DEPARTMENT
CITY OF
DATE
EDNIONDS
-7o-
PR 6-1107
/9
FILE