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BUILDING D� R®
PERMIT APPLICATION
NAME NAME OF BUSINESS)
.t �WV�LII Iit �i
Applicant Fill
Inside Heavy Idnee
MAILING ADDRESS -
CITY '�'a{1WrpV1,E NUF[B1LFi
NAME
ADDRESS
CITY TELEPHONE NUMBE!
l
NAME
�rlev,
Id 'ADDRESS
Q 6 Y 3 3
CITY TELEPHONE NUMBER
z �drno n c�S PYb-5o�-?
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Snow Below or Attach Your Copies)
LoO c II Ql LC t
�Eeo(- a ,ram 1=
_ W
0
GAS
IY l NEW RESIDENTIAL ❑ LINE
`^C
NON-RESIDENTIAL SIGN
ADD RETAIQ DEMOLISH ❑ WALL NINE
ALTER EXCAVATE FENCE
OR FILL ......Ft.)
REPAIR O MOVE swim
INSP.O POOL
NUMBER OF STORIES I ELLING
vNBB MNn VF
ITS
NATURE OF WORK TO BE DONE
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C-
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10
ZONE
S 1
ST
30'
NO.; PERMIT
NUMBER
Q I�
STREET ETBACK
�R 5
LOT AREA
i2. 40 o
EXISTING STREET R/W ... _...... FT. DEFICIENCY TRIG PROPERTY
COMP, PLAN ST, R/W ...........I", ............FT.
REMARKS
FIRE ZONE TYPE OF COON STREET IMPROVED
- I �7 NSTRU ,'t I o YEB
SPECIAL INSPE_CT�OR REQUIRED OCCUPANCY GROUP -
YES TJ +,O I
PLAN CRECKED BY
THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04,.
A4.e0Wfr,P 6r1G V.I%/5i5r J (S G /q 7 D
Valuation I Fee I Receipt'
-No.
Plan Check Not ....... . .
.. .......
BUILDING
PLUMBING
BEAT Q GAS LINE
FENCE
SIGN
RETAINING WALL
N
I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
L.Permit
hereby acknowledge that I have read this application; that the In.
on given is correct; and that I am the owner, or the duly author.
ent of the owner. I agree to comply with city and state laws regu- ATTENTION
construction; and In doing the work authorized thereby, no person
employed In violation of the Labor Code of the State of Washington THIS PERMIT
to Workmen's Compensation Insurance, AUTHORIZES
ONLY TIM
: Permit Limit' a our ( t DEMOLITIDNS which pVOgg NOTED
completed Sn nlnet MOVED- 6 1 be com-
n six monthURE (OWNER O AO NT) ATE SIGN D INSPECTION
DEPARTMENT
CITY OF
; EDMOND3
NOTE: Applicant Subject to Plan Check Fee PH OND
6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the publle domain (curbs, sidewalks, driveways,
marqures, etc.) wW require separate permission.
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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-
lmowledged in space provided.
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