710029.pdf_.---._.______ __.....
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME
M MAILING ADDRESS
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Applicant Fill
Inside Heavy Linos
Iw or Attac
Yr
PERMIT
NUMBER
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710029
SIDE YARD SETBACK
STREET SETBACK I
REAR YARD SETBACK
USE ZONE
6?
I LOT AREA
VACANT BITE
I❑YES ❑NO
BUILDING AREA
VARIANCE NUMBER
F[EIGHT PLOT PLAN APPROVED
STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
WW42M
DEFICIENCY THIS PROPERTY
OF C TRUCSTREET IMPROVED
D I ❑ YES XNo
R QUIREL (OCCUPANCY GROUP '
07
RESIDENTIAL
NEW
GAS
LINE
YE
❑S �,NO
PLAN CHECKS
BY
�
ADD
NON-RESIDENTIAL
❑ SIGN
RETAINING
REMARKS
El
WALL
^)64�
EXCAVATE
PENCE
V6fl�
/6 /36-
ALTER
OR FILL
(xFt.)
❑
REPAIR
PRE -MOVE
INSP.POOL
.......... ..........
SWIM
❑
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A& � _&D J / — zd
NUMBER OF STORIES NUMBER OF
DWELLING
I
UNITS
NATURE OI•E WORK TO BE DONE
Valuation
Fee
Recelpl No,
t O / le f
C21 o o*i S l
Plan Check No .....................
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BUILDING
PROPOSED USE
U
aPLOT PLAN (Indl
5
O
PLUMBING
BEAT & CAS LINE
FENCE
SIGN
1
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that t]1nn
formation given Is correct; and that I am the owner, or the duly aIzed
agent of the owner. I agree to comply with city and state laws
ATTENTION
lacing construction; and in doing tho work authorized thereby, no
will be employed In violation of the Labor Code of the Hints of Wash
TFBB PERMIT
relating to Workmen's ComDencatlon Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVER -IN BUILDINGS shall bpleted
In six months.)
31GNATURE (OWNER OR AGENT) DATE SIGNEINSPECTION
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant Subject to Plan Check Fee
PR a-IIo'1
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 permission.
1 S_-O D iis-`G 3
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-
knowledged in space provided.
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