710178.pdft�
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POSTED ON KROLL MAP NO.; I 2P4EUM 1TT
ER
BUILDING
DEPARTMENT
Applicant Fill
_-
PERMIT
PERMIT
APPLICATION
Insldo Heavy Linos JOB
ADDRESS
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INAME (f)ti'if7[ffiF.-II1rDCE2lf>�9f�
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SIDE YARD SETDACK I STREET SETBACK I,I
C4 MAILING ADDIs 8
G ........ � TELEPHONE NUMBI.R
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Cd U ADDRESS
W CITY I TELEPHONE NUMBER
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8 ___ --................... . Wimp r.rnF.NRF. NUMBER
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NEW
ErADD
ALTER
V�RESIDENTIAL
❑ NON-RESIDENTIAL
LAS
INE
SIGN
yEALL KING
PENCE
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❑
❑ DEMOLISH
El OR EXCAVATE
❑
REPAIR
O IN P.
wim
P OL
QUI%IBER OF STORIES I NUMBER OF
i DWELLING
I UNITS
710178
❑ YES
iD SETBACK
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jITE
NdNO
, U1vIBER
S
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EXISTING STREET n/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
ZONE
❑ YES ❑ NO
REMARKS
_
Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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; AIOVF.D-IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER Olt AGENT) DATE S16NED
NOTE: plicant Subject to An Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (turbo, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
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❑ YES ❑ NO
Fee
TOTAL AMOUNT DUE
I
I C,t i O p
V J a )a,
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S SIGN RE
DEPARTMENT
CITY OF
DATE
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EPR B-1107
PR a-uo�
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_.. _. _.. RECORD OF INSPECTIONSdd
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Date Pass
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Plumbing (Partial) PI arti0 Ott
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