740397.pdfe
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BUILDING DEPARTMENT ZONE "U"B
Appllnnt Flll 740391
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PERMIT APPLICATION Inside Heavy Lines
NAM R NAMO OP BUSINESS/
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DIAMA—ISO ADDRESS
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CITY TELEPHONE NVMBE
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NAME
W ADDRESS
JOB
8I1IN
ADDRESS
PERMIHBIBLE ^
ACTUAL
IAT COVERAGES 3+ O
LOT COVE AGE
PERMISSIBLE REIGHT �O
Plj/ll:t)�BE�IEIlH'Ls�/
ACTUAL LO(%'T
OIVaE �
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ftEQUI D VAItDs
F PIWFOSEIPYANDS
FRONT HIDE REAR
FRONT e[D REAR
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LE ,LOT VAIt A CE OR CONDITIONAL ..E
E8 0 No PERDIIT NUMBER
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M/ -�y PLA O llEPT Y OV _
CITY TELEPHONE NUMBER r•
Ep/Yr o n�19S 776 6y66 E ET � /^ y� 0
EXIBTIN STREET R/IKSL.: .ILaYt'. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/t� b.&r. ....L/....FT. I
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ADDRESS y L o j� REMARKS Driveway slopes not to exceed those e
G� /��-/� indicated on Standard Drawing No. 103 W
! O t/ CHECKED SY
F CITY /�� /�/t TE/L/EJPHONE NUMBER ��IJWC-f.�lCfa/11�n in1'�n �p I Ti
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0AI / I / ,7gx� 40 M jT1D�HJ� IZE I BfE VrE 8IWZE1C. CLEI'AIRANC I Ch ECC ' `BY
O STATE LICENSE NUMBER CITY LICENSE NUMBER 7 1//
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�7a � + r
Legal Description of Property (Show Below or Attach Four Copies) R(�' ^^ _ �n 1n�� t�(t� um \c /Z r
TYPE CONNECTION V C VIM
TYPE DBY1 •J i
0
S• PERC. TEST I P -R NUDSHER E
n
6 /
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E REMARKS •W/, I I
ii� FIRE E TYPE OF CONSTRUCTION STREET 3DfPROVED
�j YES ❑ NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY OR UP
GAB ❑ YES �•NO I T^ 1
RESIDENTIAL LINE PLAN Cl1EC D
NEW � ISE THIS SITE IS LOCATED IN THE CITY j '
NON-RESIDENTIAL SIGN OFOULD EDMONBEDCODED 3S. LOCAL1.04SALES TAX
SH.
ADD ❑❑ ALL NTNG REMARKS
DEMOLISH
ALTER ❑ EXCAVATE
E ❑ PENCE
ORFILL x..........Ft.)
REPAIR ❑ INSP. DtOVE El SWBI
POOL
NUMBER Ol•• STORIES NUMBER OF 1
1 S�SMT DWELLING I
IlP UNITS
I
NATURE OF WORK TO HE DONE Valuation � Receipt No.
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t�lA� /�2„(unI �a�ItQA� tion Cheek Nn .....................
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O BUILDING 3Q. • Od `
PROPOSED USE
O PLUMeIN6 /l•/
23. bd
7 PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAB LINE
A
O FENCE
8I1IN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
a'D 79
TOTAL AMOUNT DUE
I hereby acknowledge that I he" read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
-.
tied agent of the owner. I agree to comply with city and state law. regu•
ATTENTION
APPLICATION APPROVAL
lating can.trucllon; and In doing the work authorlr.d thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TINS 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
ut and fees are paid, and receipt Is Be----
y, p
_
shall be completed In Musty days; MOVED -IN BUILDINGS shall be m-
OTE
R'ORII NOTED
knowledged In apace provided.
pleted In six month.,)
,
RONA, tE OWNER A T)
DATE efONED
INSPECTION
DIRECTOR•B
NA
DA ��D
DEPARTMENT
j )
!V�
�Qft
CITY OF
NOTE: Applicant Subject Fee
EDhiONDB
DATE
�—
to Plan Check
%i$•Z$Z$
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This Permit covers work to be done on prle.ls Properly ONLY,
Any -ll an tllr public d.mnln (rnrb., .Id, _n, driveway.'
FILE
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