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BUILDING DEPARTMENT I Applicant Fin
PERMIT APPLICATION 1 Inslde Heavy Ling
N�AAME.
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"I. M ADDRESS
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' - f STATE LICENSENUMBED ,
223 c> 9�i7
Legal DeacNDtlon at Property (89
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NEW JeN RESIDENTIAL
NON-RESIDENTIAL
ADD
DEMOLISH
ALTER - EXCAVATE
Q:. OR'+FILL
- REPAIR _ PRE -MOVE
'INSP.
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
-
D.Y » U LONE I LOT ARE
'HONE NUMBER 1
HEIGHT - I BUILDNNf
PLOT, PLAN APPROVED
STREE'�'-R/lV
'HONE NUMBER EXI8TIN6BTREFi1T R/W ...».......FT,
OAS
LINE
SIGN
y�RETAINING
WALL
❑
FENCE
(........ ..x......... R. )
SWIM
POOL
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 -
teed agent of the owner. I agree to comply with city and date laws relru.
lating construction; and in doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington
Mating to Workmen's Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months,)
NOTE: Applicant Subject to Plan Check Fee
Ttde Permit coven work to be done on private property ONLY.
Aar construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PE CO
YES
Plan Check No..... ...............
BUILDING
HEAT R OAS LINT:
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
212IDDAii Moil
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMOND9
Pit g-1107
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ea...•:.,.+oe+r ass,.
,..-•, ni
i.`
PERMIT
NUMBER
-
CK
RAAR YARD SETBACK.
.
O
VACANT SITH
O YES 13 NO
•'
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lIAA �
VARIANCE NUMBER
i
•
i
DEFICIENCY THIS PROPERTY
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CHECKED BY
I
HANCE
BY
IORECKED
✓ERIFIED BY
7ERMIT NUMBER
I
M1 '
I
4N STREET IMPROVED
•j
YES 114I0
iECUPANCY GROWN
APPLICATION APPROVAL i
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac- I
knowledged in apace provided. PI
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