710439.pdfAlt�
POB'rIDD ON KROLL MAP NO.: PERMIT tN
BUILDING DEPARTMENT Applicant Fill I NUMBER 710439 c'
PERMIT APPLICATION Inside IIeavy Lines JOB ADDRESS,
NAME l0� NAME OF BUd1NEBd) ,� Y�rX _/ / �e 5/'Cee�
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STATE LICENSE NUMBEIt e;?I o�Z3-0/ __P 9/ 20
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Se
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77F-a!
RESIDENTIAL
R
LIN
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❑ NEW
E
NON-RESIDENTIAL
❑
RION
ADD
kLzTAINID NG
13
WALL
ALTER
❑
DEMOLISH
OR FILL
0
PENCEs.Ft.)
.......
El REPAIR
Q
PRE -swim
INSP.
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
�1,
❑ YES ❑ NO
EXISTING STREET R/W ........ ... FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
❑ YES ❑ NO
Valuation
❑ YES ❑ NO
Ze1 / of c( —
Plan Check No ......... ......_...
BUILDING
PROPOSED UBE
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
I
PLUMBING
HEAT A GAB LINE
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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No.
NT DUE
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I hereby acknowledge that I have read this aPPllcatfon; that We lo-
formation given to 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-TION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no Person
will be employed In violation of the Labor Code of the State of WashingtonRMIT
This application is not a permit until
relating to Workmen's Compensation insurance.
RIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS whichOTED
rANT
THE
Uty; and fees are paid, and receipt is ac-
shall be completed 1n ninety days; MOVED -IN BUILDINGS shall be oom-kaowledged
in space provided.
Dieted In six months.)
116NATURE (OWNER OR AOENT) DATE SIGNEDTION
D OI 6NATU
MENT
InA
OFDATNDS
NOTE: Applicant Subject to Plan Check Fee
—oR (�
PR a-Ilov
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (carbs, sidewalks, drlvowgs,
FILE
marquees, etc.) will require seParate permisslm.
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