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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
IIeavy Linos
POSTED ON KROLL MAP NO.: PERMIT —' r. 1
I NUMBER , I G J f
JOB ADDRESS
aA 13 a 8
NAME (OR NAME OA�F•• BUSINESS)
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SIDE YARD SETBACK I
STREET SETBACK I
REAR YARD SETBACK
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MAILING ADDR S8
IN •
USE ZONE
LOT AREA
I I
VACANT BITE
YES jg NO
CITY /I
V
TELEPHONE NUMBER
HEIGHT
BUILDING AREA
I 14C
VARIANCE NUMBER
/
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NAME
PLOT PLAN APPROVED
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ADDRESS
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
/W ........... ............FT.
COMP. PLAN ST. R .FT.
CITY
TELEPHONE NUMBER
REMARKS
NAME04 G
U
ADDRESS
CHECKED BY
—_
Z,
S
CITY
I TELEPHONE NUMBER
METER 812E
I BERVICF. BILE I CLEARANCE
j CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REI3ARKS
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Le al Description of Property (Show Below or Attach Four Copies)
TYPE C014NECTION
I- VERIFIED BY
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PERC. TEST
I PERMIT NUMBER
WREMARKS
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
._ 0�J.YES [3 NO
RESIDENTIAL
❑
OAS
LINE
❑ YES `(� NO
❑ NEW
PLAN CHECKED HY
❑
NON-RESIDENTIAL
❑
SIGN
THIS SITE IS LOCATED IN THE
CITY OF: r=9mep,es
ADD
El
DEMOLISH
❑
RETAINING
WALL
REMARKS
0 AI- SALES
TAX SHOULD BE CODED 31.04.
® ALTER
❑
EXCAVATE
OR FILL
❑
FENCE
(Ft.)
........ „x..........
IJ(f ReC-r(O'
❑ REPAIR
❑
INSP.
❑
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POOL -.,.
ST%L,UC To/W-i,�
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
5ko
Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE p
`J
FENCE
SIGN
tRETAINING WALL
N
I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lzed 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 We Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
)lGN RE ( IVNER O ENT)
DATE SIGNED
INSPECTION
/
DEPARTMENT
CITY OF
ED11fONDS
TE: nppr nt Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permleslon.
Valuation I Fee
No.
5-0 K63L
,
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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