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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME WWI"
9�.
or
Applicant Fill
Inside Heavy Lines
POSTED ON KROLL MAP NO.:
PERMIT
I NUMBER
710163
JoB ADDRESS
w FS
SIDE YAR SETBACK
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STREEET SETBACK
�7 1t�V�- I
REAR YARD SETI
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I LOT AREA I
[3 YES T SITENC
,EPHONffi NUMBER
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HEIGHT
I BUILDING A2ffihf
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I VARIANCE MBI
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NEW
RESIDENTIAL
❑ NON-RESIDENTIAL
❑
LINE
SIGN
EfADD
ALTER
REPAIR
❑
❑
n
DEMOLISH
OR EX
PRE -MOVE
INSP.
❑
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I l
RETAINING
WAIT'
FENCE
A .......... Ft.)
SWIM
POOL
DWELLING
UNITS
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES
DEFICIENCY THIS PROPERTY
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❑ YES ❑ No
!o X! Z Urn. yoe¢" hatm
/ K 4el ;" 6"C,it 10 "#*j" S
Plan Check No........
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
♦I
Fee
No.
I
TOTAL AMOUNT DUE
S d0 DO
✓
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 end state laws regu-
ATTENTION
APPLICATION APPROVAL
lacing 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 PERMIT
This application is not a permit Until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In. ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
OWNERLOENT) D E If
8WAr
INSPECTION
DDIECTO SI
DEPARTMENT
1 a
CIOF
OTE: Subject to Plan Check Fee
EDMONDB
DATE
Applicant
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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