710424.pdfr
POSTED ON KROLL MAP NO.: IPIELJMB TR
BUILDING DEPARTMENT Applicant Fill 7 10424
PERMIT APPLICATION Inside heavy Lined JOB ADDRESS
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TELEPHONE NUMBER
NAME
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CITY TELEPHONE NUMBER
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TELEPHONE NUMBER
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STATE LICENSE NUMBER -
CITY LICENBE.NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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❑ NEW
RESIDENTIAL
❑
GAS
LINE
❑ ADD
NON-RESIDENTIAL
EJ
SIGN
RETAINING
❑
DEMOLISH
❑
ALTER
❑
EXCAVATE
ORFILL
❑
(ENC x
Ft.)
..........
❑ REPAIR
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PWIM
OOL
DWELLING
UNITS /
YAR
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❑ YES [3 NO
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HEIGHT - -
I BUILDING AREA I
VARIANCE NUMBER
PLOT PLAN APPROVER
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STREET R/W -- - - - -
EXISTING STREET R/W .: FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/W ...........Fr. ......... FT.
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REMARKS
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- - - -- - - -
I CHECKED BY -
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METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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REMARKS
TYPE. CONNECTION - I
VERIFIED BY
PERC..TEST - - ,I
PERMIT NUMBER -
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REMARKS - _ - _..
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&SVIN 7-
FIRE ZO - .TYPE OF CONSTRUCTION STREET IMPROVED
I / I [3 YES ❑ NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY UP
YES' �%KNO
PLAN CHECKED 1 1 THIS SITE IS LOCATED IN THE
AtL
1176
Plan Check No .....................
BUILDING
PROPOSED USE (`
'a7 PLUMBING 3
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aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAB LINE
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I hereby acknowledge that I have read this application; that the In-
formation given 1s correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In Violation of the Labor Code of the Stale of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shall be completed in ninety days; 11IOVED-IN BUILDINGS shall be com-
pleted In six months.) f
NOTE: Applicant Sfibject to Plan Check Fee
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
SIGN
TAX SHOULD BE CODED 31.04 j
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Valuation Fee Receipt No.
26,6 J
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I lov
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' IONA74
DEPARTMENT
CITY OF DATE
EDIIIONDS ��
PR 0-1107
FILE
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