710100.pdfj - POSTED ON KROLL MAP NO.: PERMIT
!E BUILDING DEPARTMENT 7111eavy
Fill NUMBER
PERMIT APPLICATION ! Inside Lines JOB ADDRESS »
NAME (OR NAME Or BU8INE8 )
p n D / Hrr p 91DE YARD 8 TBACIC TREET SETBACK
04 MAILING ADDR/E88 , A ��� ry,% U E Z0146 <—ILOT AREA
h.R f/J/I
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(5'
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RESIDENTIAL
GAS
LINE
1 JAI NEW
I
❑
NON-RESIDENTIAL
❑
SIGN
ADD
a
❑
RETAINING
DEMOLISH
ALTER
❑
EXCAVATE
❑
FENCE
OR FILL
FILL
<x..........Ft.)
REPAIR
O
PRE-❑SWIIA
IN P.
❑
POOL
IUMHER OF B'rOR1ES
NUB113ER OF
DWELLING
UNITS
l ._
❑ YES
E ISTIN ET. R/W 'STRE.. ..Fr. DEFICIENCY THIS PROPERTY
..l_.l..Fr.
REMARKS
Driveway slopes not to exceed those indic,
on Standard drawing #103.
❑ YES
MARKS
XJa N Ei
TYPE — I/ R SIC
" K_
Svt3J1ZcT r
Valuation
Plan Check No .....................
BUILDING
PLUMBING
`
tRETAINING
N
I
HEAT do GAS LINE
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; jbo�m-
pi,ek-ginIn-
formation given to correct; and that I om the owner, or the dor-
Ized agent of the owner. I agree to comply with city and stategu- ATTENTION
IallaB construction; and In doing the work authorized therebyson
will be employed In violation of the Labor Code of the State of ton THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIwhich ONLY THE
WORK NOTED
shall be completed In ninety days; DIOVED-IN BUILDINGS shcorn
-
plc in six m the.)
TURE WN Ofi GENT) DATE 8SNBPECTION
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant Subject to Plait Check Fee
I'It 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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la:lif � t1
STREET IMPROVED
YES NO
ROUP
r )
Fee
0 tQ a
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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k 1 RECORD OF INSPECTIONS
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