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[ � � BUILDING I)EPARTMEN'
PERIIAIT APPLICATION
NAME (OR NAME OF HUBINEBW
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NUMBER OF STORIES
NUMBER OF
DWELLING
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4 I PROP09ED USE
Ci I PLOT PLAN (Indicate Bullding eetbacke, abutting et
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I heroby acknowledge that I Gave read this appllcatlon; that the In-
formatlea gluon U correct; and tbat I am the owoer, or the dulq author-
ized agent b1 the owner. I agree to comply wll6 city and elate lave rogu-
latla6 coneteuclloa; and !a dolog the work aulhorizad theroby, ao person
will be employed In violation of the Lnbor Coda of the elate of Waehmseon
rolatlag to Workman'a ComDeaeatloa Iaeuraoce.
NOTE: Permit Limit One Year eE:eept DEMOLITiONB which
completed Ia Nnety days; MOVED -IN IIUII.DINCB ehatl bs wm-
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NOTE: Applica Subject to Plan Chrck Fee
T61■ Pemtlt coven work to be done on Drlvate pnpertl ONLY.
Any eoaetractlon on the pab8e domain (elabe, eldewalW, drivewye,
maraueee, eta.) wW re0mre eeDante permleelon.
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NO.; PERMIT 11 �I l�ccri! '7
NUMBER [�• �.
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ems' I ��s'
EXISTING STREET R/W ............FT.
COMP. PLAN 8T. R/W ............FT.
YE8 � NO
YEa � No
DEFIOIENOY THIS PROPERTY
............FT.
YE9 n xo
cuna� Vgdy{L,yL Di
THIS SIT[ IS
. 4,p^CN:?S. l_�';AL SOLES
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HEAT d: 6Aa LINE
FENCE
BION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
ADTHORIZEB
ONLY TF1E
WORN NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMONDB
PR 6.1107
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APPLICATION APPROVAL
This appllcaUon is not a permit tmtil
elgned by the Bullding Official or hie Dep-
uty; and fees are paid, and receipt is ac-
knowledged 11t space provided.
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