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BUILDING DEPARTMENT
' PERA�IT APPLICATI®N
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Applicant Flll
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_ Legel DasctlpUon o[ Property (Show Below or Attach Faue CoDles)
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RESIDENTIAL DAB
NEW � LINE
NON-RESIDENTIAL ❑ BION
ADD RETAINING
DEMOLISH � WALL
ALTER ❑ ORCFILL E ❑ FEN .S_........Ft,)
REPAIR ❑ INBPMO� � P OL
NUMBER OF 8TORIEB NUMBER OF
DWELLING
UNITS
NATURE OF WORK DONE
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;C�2y PROPOSED UBE
a PLOT PLAN (Indicate Building eotbacke, nbutting streets)
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I hereby ackhowledge that I Gave read this appllcatlon; Hutt Ws Ia-
formntlon given le correct; and that I am the owner, or the duly author-
ised agent of the owner. I agree to comD1Y with city and stele lave ngu-
Iatlhg cohstructloh; sad In doing the work authorized Ularoby, no Deraoa
will ba employed 1n vlolntloa o[ We Labor Code of lba State of Washington
relating to Workmen's ComDensatlon Ioaurmu.
NOTE: Permit Limit One Year (Ezcept DEALOLtTIONB whlen
shall be completed In hloety days; MOVED-iN BOILDDY08 shall be com-
plated la slz months.)
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to Plan Check Fee
Tht► Yertnit coven work to be done on private properly ONLY.
Any eohslruetlon on the pohllo domain (curbs, sldewdks, drlvewwya,
mnr0uces, e1eJ will reOWre separate permlulon.
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NO.; PERMIT
NUMBER
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EXISTING STREET R/W ..._.......FT.
COMP. PLAN 8T. R/W ..._.......FT.
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41i'f;7 ir.
YE8 � NO
DEFIOIENCY THTS PROPERTY
VWuatlon
Plan Check No...._.._.._.._...
BUH.DIN6
PLUMBING
HEAT � GAB LINE
FENCE
BICN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE•MOVE INSPECTION
EXCAVATION OR FILL
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CRECKED BY
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CHECKED SY
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TOTAL AELOIINT DOE I I /�_1 O� SCJ1oi � 1
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ATTENTION APPLICATION APPROVAL ! � '
TIHB PERMIT Thla appllcatlon is not a permit untll
AUTIIOAIZEB signed by the Building Official or hlB Dep- i �
ONLY THE � .. t
WORN NOTED uty; and fees are paid, and receipt is ac- i . I i
knowledged in Space provided. i ;
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INSPECTION DIRECT '8 8I0 R ' �
DEPARTMENT I
' CITY OF �'
EDMOND$ DATE r�/ i �
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_ I?MRD OF INSPECTIONS
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Date Passed
3 ,
Foundation f. :.�
is -
- Plumbing (Part I) % I I`
(Rough); wPI.
Frame.k.
Furnace & Fuel dLines _
WZAop Final
RECORD OF INSPECTIONS
'r r� Date Passed
Drainage---
�,; Sewer d o',•
Parking d
Landscaping f
_ Fire Dept.