700347.pdf-� au��v�nv v�rwR�misn� AppllcantP911
PERMIT APPLICATION IRBide Heavy L1Des
NAME (OR NAME OF BU8nQE88) ^
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CITY� p TELEPHONE NUMBER
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RESIDENTIAL ❑ LINE
NEW ❑ NON-RESIDENTIAL
BION
ADD ❑ DEMOL28H ❑ w�Iy NINE
ALTER ❑ ORCFILL E � FEN ac_.......Ft.)
REPAIR ❑ IN8PM0� � POOL
)UMBER OF STORIES NUMBER OF
DWELLING
UNITS
QATURE OF WORK TO HE DONE
�'i9-R A 4 E.
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I
I hereby ackaowledae that I Gave read thle application; that tha !n-
[ormatlon alvea le correct; and that I am the owner, or the duly author•
lied anent of the owner. I cares to comply with Illy and dale Inwe reau-
latlni coaetructlon; cad la dolnt the work authortred thenby, no parson
alit 6e employed In violation of Ne Iabor Coda of lha elute of Waahlaaton
nlatlaa to Workmen's ComDeneatlaa I¢eurauu.
NOTE: Permit Limit One Year (Except DEMOWTIONe whleti
shall be comDieled In alnetY days; MOVED -IN DOILDIN08 shell be com-
Dleled In dz months.)
B1ONA i RE (OWNEjt Oli A6Eji�1 I DAT BfONE
NOTE: Applicant Subject to Plan Check Fer
This I•ermlt coven work to !w done on Drlvate DnDerlY ONLY.
Aay eoadruetloa on the Dublle domain (curbs, ddrwslW, drlrewgs,
nuirCueee, etc.) will repaln separate Dermlulon.
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ARD 8
o'
>NE
EXISTING STREET R/W ......._...FT.
COMP. PLAN BT. R/W ............Sr.
❑ YEB
Place Cheek No...._......_.......
BUILDINa
PLUMHIN6
�=i74�1_�FG\�f w 4iL:�
FENCE
BION
RETAINING WALL
"•I li.'.i'i � e • .
���[•2+r Y�1i�35
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHOItIZE6
ONLY TI[E
IVOItII NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMOND$
ru actor
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t VAOANT 81TE
❑YES k] NO
DEFIOIENCY THIS PROPERTY
............FT.
STREET IMPROVEI
❑YES ❑NO
OROUP
r-
Valu¢tlon I Fee
' ,..
APPLICATION APPROVAL
This appllcaUon is not a permit until
signed by tho Building Official or hie Dep• � , �
uty; and fees aro paid, rind receipt !s ac- i
knowledged in space provided. I ,i
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