750116.pdfi
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BUILDING DEPARTMENT ZUOSNE NUMBEIR
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PERMIT APPLICATION insidepHeavy 00HAD
DRESS
(OR NAME OF H 81NEBS)
IF,
PERM J ACTUAL
LOT COVEi�AOE
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IAT COVERAGE�r_ /..
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MAILING ADDRESS / O
PEIta11tl8IBLE HEIGHT PROPOSED 1.1E I
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TOTAL DT
C1T� TQELEPHONE�jNUMBER ACTUA%iOT Ali'Aq
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/ �( , REQV REO YARLH PROPOSED YARDS
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NAME FRONT BIDE REAR FRONT SIDE REAR
a2s' lo, 40 is y al"
LEGAL LOT VARIANCE Olt CONDITIONAL USE
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ADDRESS
Qf YES NO PERMIT NUMBER
PLANNING D P PROV DATE:
CITY TELEPHONE NUMBER
BTttEET R/W �� ,,����V
EXISTING STREET R/W4.'.'r:(1 .T. DEFICIENCY TR28 PROPERTY
N COMP. PLAN ST. R/VJ4:LC4.i
RDldARKS es not to exceed those
Driveway slopes
v
ADORES
J indicated on Standard Dwg No 103
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Gl CHE E BY
CIT
TELEPHONE NUMBER
07
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lA 6 3 X60 Z MET SIZE 8E 1 E SIZE CLEARANCE
CR C ED BY
BTA OENOBH�NUMHER CITY LICENSE NUMB R I x/17
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Legal Description of Property (Show Below or Attach
Atttaacchq.Four Copies) R H^ Qj_
1573
Lob //r '8Z de k /• O-J (, a l L , TYPE C NN/EC—TION ERIF Y
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PE R I NUMBER
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T IMPROVED
Fl I TYPE OF CONSTRUCT ON O YEB
1Z ❑
SP ECIAL INSPECTOR REQUIRED OC.C•JU—PAN%QE.'Y GROUP
RESIDENTIAL ❑ CAB YES ANO y �
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LINE PLAN CHECK D IIP f
NEW THIS SITE IS LOCATED IN THE CITY
Of 10MONDS. LOCAL SALES TAX
NON-RESIDENTIAL ❑ BION
SHOULD 6E CODED 31.04.
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ADD RETAINING REMARKS
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DEMOLISH E WALT
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El ALTER ❑ EXCAVATE ❑ FENCE 73
ORFILL (..........x..........Ft.)
SWIM
pMOVE D
REPAIR ❑ NSP POOL
NUMBER OF
NUMBER OF11/1
j DWELLING
= I
1 •ll1 UNITS
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NAT RE OF WORK TO BE DONE
Y.laation
Fee Receipt No.
Plan Check N.
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BUILDING
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PROPOSED USE ��
PLUMBING
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aOT
PLAN (Indicate Building eclbacAce�nbuttln ....is) HEnT d: GAS LINE G 60
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\ FENCE
SIGN
RETAINING WALL
�1 SWIMMING POOL
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DEMOLITION
' O PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In- d
(.,mall*' given is correct: and that I am Its owner, or the duly author-
Ited as of the owner. I agree to comply with city and elate laws regu-
and
lating eonst,uctlon; and In doing the work authorized thereby, no person
will be employed In of the Labor Code of the State of Washington TIDE PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORITILE ZER
signed by the Building Official or his Dep-
ONLY
NOTE: Permit Limit One Year (Except DEMOLITIONN which WORK NOTED uty; and fees are paid, and receipt is ac-
.he ll be completed In ninety days; MOVED-1N BUILDINGS shall be corn-
Itknowledged !n apace provided.
pleled In el. menthe.)
(OWNER OR AGENT)DATE SIGNED INSPECTION DIRECTO 810 A
JATURE
DEPARTMENT ,
CITY OF
ED51ONDS DATE
NOTE: Applicant Subject to Platt Check Fee 3 — 2-7-- 7S
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775-2525
This Permit rot work to he done on privole property ONLY.
Any c*netructlun on the public domain (curbs, sidewalks, drWeways,
murqueee, 'tr.)will require cepnrate permisrlon. FILE
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