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PERMIT APPLICATION Inside Ileavy e8 JOB ADDrR�E88
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LOT PLAN APPROVE;
NO.. PERMIT
NUMBER
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710463
YARD SETBACK
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9b..... FT. DEFICIENCY THIS PROPERTY
TELEPHONE NUMBER EXISTING STREET R/W ...
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Uy COMP. PLAN BT. R/W.... FT. Q••FT• t7
D��y <7 O( ,5 7 7 _ REMARIce Driveway slopes not to exceed those
NAME indicated on Standard Drawing #103. w
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CHECKED BY
CITY TELEPHONE NUMBER
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p 3 O MET SIZE BERrVICE SIZE CLEARANCE C1iECK t - BY
U A LI ENBE MBER — CITY LICNI43t; I UMBER � �� I •J,I �t( I I 1p. )
REMARKS J 7 1 �t�v`/ p
Legal Description of Property (Show Below or Attach Four Copies) UPC \Ot l� v
N 1 Ir TYPE CONNECTION I VERIFIED BY
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FIRE ZO I TYPE OF CONS T UCTIOtf I STREET IMPROVED
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SPEeIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GA13 ❑ YES ❑� I �! �` I
RESIDENTIAL LINE PLAN CHECKED Y THIS SITE IS LOCATED IN THE
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NON-RESIDENTIAL ❑ SIGN Ct/`•� CITY OF EDMOND L7CODED31.04
ADDRETAA.INING REMARKS TAX SHOULD BE
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❑ ALTER EXAVA❑ ORCFILLTE ❑ FENCE ..........Ft')
REPAIR El IRE -MOVE SWITA
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO DONE Valuation Fee Receipt No.
v Plan Check No .....................
[Z BUILDING
q PROPOSED USE
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a PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAB LINE
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0 FENCE
SIGN
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ISWIMMING POOL
DEMOLITION
PRE -MOVE, INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE ! _ 30�
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-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington TIUS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE and fees are aid, and receipt is ac-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED Uty; p P
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- Imowledged in space provided.
pleted in six months.)
SIGNATURE (OWNER Ol4�1t AGEN ) DATE SIGNED INSPECTION DIRECT R'S 81 T
v DEPARTMENT
57 D � CITY OF
EDIVIOND$ DATE
NOTE: Applicant Subject to Plan Check Fee PR OND
0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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