690224.pdfwnewmvalmauuwwn
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF 33 �1 N 88)
;;16N1�3 J). A,Ji>c2riJ
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AS
NEW RESIDENTIAL■ `,
■NON-RESIDENTIAL SIGN
■
�, 1 1 ■RETAINING
■ DEMOIJ WALL
ALTER EXCAVATE FENCE
REPAIR PRE -MOVE swim
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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-
ised agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorised thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in aluety days; MOVED -IN 131I1I1DINOB shall be oom-
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an private property ONLY.
Any westructien on the public domain (curbs, sidewann, driveways,
marquees, etc.) win require separate permission.
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690224
/ ("1 I I rl YES
U87ING STREET R/W ........... p , DEFICIENCY THIS PROPERTY
COMP, PLAN ST, R/W ....... I .... p o ......._...FT.
WA
EXCAVATION OR
f
Valuation I Fee
To b O
A
No,
TOTAL AMOUNT DUE I I / 31d O I
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORE; NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION :P(e
W�wd'
CITY OF rJonme • it r D:
PH 6-1107
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