700096.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF TUSINESS)
W
MAILING ADDRESS
C:?
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CITY
TELEPHONE WU—MBER
if Af S-s? 7 V-3
ADDRESS
Awa — /0. ;7,s
T MBER
/—/ / 9
NAME
e,
zkeey_, 9 IV 0
CITY
TPLEPHUNN NUMBER
STATE LICENSE WU—MBER CITY LICENSE NUMBER
Legai �escripuon or Property (Show Below or Attach Four Copies)
RESIDENT AL GAS
NEW L NE
NON-RESIDEN
ADD =Lj F SIGN
RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL
( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER Or STURE—,i NOMBER 02,
DWELLING
UNITS
NXTUR35-601 Wolin, 13E DONE
7-
PROPOSED USE
PLOT PLAN (Indl.t. mullulug GOLDacKso abutting streets)
N
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-
Ized agent of the owner. I agree to Comply with city and state Iowa regu-
latIng construction; and In doing the work authorized thereby, no Person
will be employed In violation of the Labor Code Of the State of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be rom.
Pleted in six months.)
SIGNATURE (bWNEIt
DATE TI�GNED
4C' . A,Jge��e_,
fe,_& /9 - 7 a
NOTE: Applicant Subject to Plan Check Fee
This Pernnit COVM work to be done on private property ONLY.
Any construction an the public domain (carbs, sidewalks, driveways,
roargueea, etc.) will require separate permission.
ROLL MAP NO.�. PERMIT 7 00096
1 NUMBER I
/0
1
=;2,,5`
a
LOT
9YES 13 NO
BUILDING AREA
VAIlUANGN NUMBER
I ftf— -% � �
EXISTING'STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ..... ar"T.
REMARKS
Driveway slopes not to exceed those
indicated on Standard !Tr —a ing #103.
_5" 15' t10 r= rV
YES tINOO
_19L_�11 1,
1jy
Sq Vk-R-bolm
Valuation
Plan Check No .....................
BUILDING
PLUMR NG
EEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
"X V
0 YES 21015OT-0
M11
No.
POTAL AMOUNT DUE
I I
AWIP
ATTENTION
APPLICATION APPROVAL
THIS PErtinT
This application Is not a pem-dt until
AUTROBIZES
ONLY TILE
isigned by the Building Official or his Dep-
WORIE NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATUILE
DEPARTMENT
CITY OF
EDIVIONDS
DATE *4'
PR d-1107
FILE
9
TE