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i'OBTIDD ON KROLL MAP NO.: PIDRMIT � 6 /O I OS
BUILDING DEPARTMENT APPLaantPYll E" ���
PERMIT APPLICATION Ian(de Heavy Llnee aoB wDDRIDeB
NAMIa (ORA AMD OP SUBINIDBB) � ��.
/G� G+ � BiDID YARD BETHAOK BTRID BET AOK AIDAR .YARD OIDTBAO�
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r,�,1 (/11 Vi/yL/ ,r' r' BID 20NID LOT ARIDA ACANT
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PROPOBIDD UBlil
f;4y BUILDING
Q PLOT PLAN (Indlcato Bullding eetbecke, abutting etroets) PLIIMBIN6
0
'e BIDAT do GAB LIVID //
G F
FENCE)
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N
RIDTAIEIIN6 WALL
BWIMMIN6 POOL
DIDMOLTPION
• PRFrMOVH INBPIDCTION
EOCCAVATION OR FILI.
TOTAL AMOIINT DOE
I hereby eckaowtedge thnt I Gave road thL aDDllcallon; that the la-
formntloa gluon U correct; sad that I am the owner, or the duly autboe�-
lsed egeat of the owner. I agree b comply with city and elate lnwe rogu- ATTENTION
latln6 ooaltNatloa; and la dolog the work auWorlm6 theroby, no Dorton
wfU be employed In vlolallon of the Labor Cods of the Btnte o[ Wmhfngton TRIB PERART
rotating to Worltmea•e CompmenUoa Iwutanee. AUTIIpItIZEB
NOTE: Permit Limit One Year cID:aepl DEMOLIT10N8 whlah °M'Y '�
woes NOTED
shall be camDleted W olnety days; MOVHD-IN SUILDINOB eha11 be com-
pleted in efz months.)
Bi0 A (OWNER OR AOIDNT) DAT BfONIDD INSPECTION
M ,AI �J�.4 Y � �� � r � DEPARTMESNT
V .'l II I/�� OITY OF
EDMONDB
NOTE: AQ�I7can! Subject to Plon Cbeck Fee
_ rR a-IIOT
TNe Permit oovees work b fro done m Drlvnte propsrt7 ONLY.
Any oouetructlon an the pnbllo domalo <anrbe, eldewWu, driveways,
marquees, eta.) wBl reQWro separate perWseloa.
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APPLICATION APPROVA�-
Thla application !B not a permit until ': ,
signed by the Bullding Official or hie Dep-
uty; and feeB are paid, and receipt iB ac- I { �
1taoWltldged la Bpace provided. f � '
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