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BUILDING DEPARTMENT I AppLoactFlll
PERMIT APPLICATION Illslde wavy Lmeg
� NAME '
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C TY NE
� NAME
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. � DITY TELEPIiONE ER
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- STATE LIOENeE NV OI CENtiE NUMBER
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+Legal DescrlDtlon of Property (86ow Below or Attach Four CODlee)
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RESIDENTIAL O gyp)
NEW
NON-RESIDENTIAL � BION
❑ ADD. � DEMOLISH � WALLAININ6
i � ALTER ❑ EXCAFILL O (�...N...z_........Ft.)
REPAIR n IN PMOVE ^ BWIL
. •�: , .
I heroby acknowledge that I have read this application; that the la-
[otmaUon given Is correct; and that I am the owner, or the duly auWor-
fsed ngont o[ the owner. I agree to comply with city and elate taws rogu-
]ating eegetrnCtloq; and Iq doWg the work authorized Lleroby, ao Dersoa
will be employed In violation of the Labor Code of the State of WaeDlggton
rolatlag to Workmeg4 ComDeneatloa Iaourmce.
NOTE: Permit Limit One Year (E:cept DEa70LITIONB which
shall be completed 1n mgety days; AfOVED-IN BDILDIN08 aDall De com-
pleted In elz ((aoaths.)
NOTE: Applicant
�/ O_��w
to Plan Chcck Fee
Tide Petmtt coven
work to
Oe done
on private property utvi.r.
Auy conetroetlon m
the Pabllo
domalq
(corbe, sidewalks, driveways,
marVuete,
eta.) wSl
re0alro
separate Dermiselon.
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30
EXISTING BTAE&T R/W ......._..1r'P.
COMP. PLAN BT. R/W ............F'I'.
❑ YEB ❑ NO
Pian Check Na......._..__.....
SVILDTN6
I" 1. ��•.i3�!
FENCE
BION
RETAINING WALL
SWIMMING POOL
n :H,. • 4Yi�3�l
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A110IINT DIIE
ATTENTION
TRIA PERMIT
AUTHORIZES
oNtr THE
Il'OItR NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMONDB
PR M1107
Valuation
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APPLICATION APPROVAL -'
This application is not a permit tmtA i
signed by the Building Official or his Dep- j i
uty; and fees are paid, and receipt is ac- .
Imowledged in Space provided. ;�
DIRECTO 9BIONATUR "� - ,
// � �
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