680486.pdfUII:DING DEPARTMENT AppllcantFill
PERMIT APPLICATION Inside sea�y ><.iHeB
!iAMD (OR NAME OF BUSINESS) o {�
A T} �1_�__L �6 ��Oa I
� A Douglas 47ebb
�1 ADDRESS
CITY TE PHONE
Bothell Viash. Hu. 6 -
NAME
_ B, Douglas Webb
ADDRESS
lo�l�l��1�-°. 19G �
CITY TELEPHONE
$ Bothell. 'r"lash. I Hu. 6 -
STATE LICENSE N HER I CITY LICENE
Legal DsettlDtlon of Properly (Snow Below or Attach H'ow
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.P NO.:
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REAR YARD BETBAOK �
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VAOANT BITE h
❑ YEB ❑ No
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•' ,�1 • :N •' :I �I:1'
indicated on Standard Drawing #103.
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Plso Check No....„...„._...»_
PROPOSED UBE
Single Family Ihvelling Btrzr�ixa
PLOT PLAN (Indicate 8ulldtng setbacDa, aDutting streets) PLVMHiNO
HEAT d: OAB LINE
See attached. FENCE
BION
N
I RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DIIE
I hereby acknowledge that I Dave read thL aDDBrstlon; that tDs in-
formation given is correct; end that I am the owner, or the duly nuUlor-
tzed agent of the owner. I agree to comply with city and stars Iowa raga- AITENTYON
]allDg conatrucuon; and m doing the work nuthorlsad theroby, no person
will be employed In violation of the Labor Cade of the State of Weahmgtoa TIDE PERIIIIT
relating to Workmen's Companeatlon Insurance. AIITHOHIZEB
NOTE: Permit Limit One Year cE:eepc DElf071TION8 which WORN NOTED
ellaa be completed In nlnaty days; MOVED -IN HIIILDIN08 stall be com-
Dlated In sls months.)
Il ( T) DATE SIGNED INSPECTION
DEPARTMENT
�r7 '� � G OITY OF
EDMOND$
NOTE: Ap(ilicant Subject to Plan Check Fee
PH s-1107
This Permtt coven work to be dooe on private property ONLY.
Any oonstractlon oo the DaDBa domain (oarbs, sidewalks, driveways,
\ mapoees, eta.) wW tegairo separate perndsston.
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Valuation
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APPLICATION APPROVAL j
ThiB application ie not a permit until '
,g)gned by the BuAding Official or hie Dep- i '
uty; and feeB are paid, and receipt ie ac-
knowledged in space provided.
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