700352.pdfBUILDING DEPARTMENT
PERMIT APPLI ATION
NAME (OR NAME OF BUSINESS)
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Applicant Fill
inside Heavy Lines
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RESIDENTIAL
GAS
LINE
NON-RESIDENTIA
SIGN
19111--
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FULL
PENCE
( x Ft.)
.......... ..........
E] REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
KrX U S t(�, 'P� 00 on
A ftAr- A5"P
PERMIT
MMBZR 700352
[] YES 0 NO
EXISTING I STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IT.
REMARKS
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C' /-57"
C5
or C STRUCTION
A1111
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0 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given to 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 no employed In violation of Lho Labor Coda of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
ThIs Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORH NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
PR 6-1107
[J YES [:] NO
Valuation I Fee
�06-&10 1 lZood
I
No.
T / 2 41 41 �5z -
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ae-
Itnowledged in space provided.
DATII
FILE