690057.pdf4UILD
C
EPARTMENT
PERMIT APPLICATION
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NAME
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NAME
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ON KROLL X" No.:
. Z — so I NUMB= 690057
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7 (V,Oat -
RJIAJ% XARD SET]
,RD SETBACK STREIrr SETBACK
��= I 10 YES
THIS PROPERTY
EXISTING STREET R/W DEFICIENCY
COUP. PLAN ST. R/W.--.FT.
te
13 YES Cl NO
GAS
NEW RESIDENTIAL LaVig
1 E] NON-RESIDENTLAL s,GN,
MADD RETAINING
DEMOLISH WALL
��TZR E] EXCAVATE PENCE
OR rim ( ........ . x ......... In.
REPAIR PRE -MOVE swim
rNSP. POOL
0 YES 13 NO
PLAN CH CKED BY
7
ItinMARKS
NUMBER or
DWELLING
UNITS
NPTA OF WO TO BE DONE
r
D 4e--
Plan Check No ..................
Valuation
Fee
Receipt No.
PROPOSED USE
BUILDING
0
q, 00
PLUMBING
P OT PLAN (Indicate Building setbacks, ab streets)
L
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
71
I hereby acknowledge that I have read this application; that the in-
formation given In correct; and that I am the owner, or the duly author-
,zed agent of the owner. I agree to comply with city and state laws regu-
laUng construction; and In doing the work authorized thereby. no person
will be employed In violatIOU Of the Labor Code Of the State of Wasbington
relating to Workmen's CompensLuon Insurance.
NOTE: Permit Unit One Your (Except DEMOLITIONS which
shan be completed in ninety days; MOVED.Liq BUILDINGS shall be com-
ATTENTION
THIS PER3=
AUTHOVJ2ZS
ONLY THE
WORK NOTED
""00
APPLICATION APPROVA
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
pleted In six months.)
INSPECTION
DEPARTMENT
()ITY OF
EDMONM
INS 6-1107
01 ATURE FO—WNEROR xtGENT)
VAIL= va
DIPECTOWS
5 "'1"
DATEL—
NOTE: Applicant subject to Plan Check Fee
This Permit covers wark to be ame as Private Property ONLY.
Any OmArcietion an am Public domain (Mtrbgp ddewaliks, driveways#
mareisew etc.) WiU MqVire g9p""s perimission.
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