740398.pdf7
CITY 11
TELEPHONE NUMBER
N E
M ADDHE e
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............pT.
DEFICIENCY THIS PROPERTY
............FT.
REMARKS
BUILDING
PERMIT
DEPARTMENT I Applicant Fill
APPLICATION Inside heavy Linea
USE PERMIT
ZONE NUMBER 7
IOB
ADDRESS I y )
- ' e 1
IJ•p�lE (OR NAM�EE`.,,gppF BUSINESS
td atAILlNO ADDRESS
3 I Q�&IJONE
LOTPERMISSIBLE q ALL CT L
LOT COVERAGE LOT YESiAC
PERMISSIBLE HEIGHT PROPOSED HE
CCITI
QQ'ljt.(T�
/IJ �/'�•�,
NUMBER
ACTUAL LOT AREA TOTAL BLDG.
REQUIRED YARDS PROP
BIDE REAR FRONT
NAMEFRONT
Uj ADDRESS
W
H
PERMIT NUMBER
REMARKS
NA won K BE DOVE
LEGAL LOT VARIANCE OR CONDITIONAI
C3 YES 0 NO PERMIT NUMBER
7
CITY 11
TELEPHONE NUMBER
N E
M ADDHE e
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............pT.
DEFICIENCY THIS PROPERTY
............FT.
REMARKS
rIRa vivaxra
ue ............
.nor.. .�......
YES 0 NO
CHECKED BY
METER SIZE I SERVICE SIZE
I CLEARANCE
I CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
NA won K BE DOVE
INSP. L_j POOLI
rIRa vivaxra
ue ............
.nor.. .�......
YES 0 NO
DWELLING
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
NA won K BE DOVE
❑ YES O
Valuation
I
NEW
(/nE,O,Fr�
"tom r '
LINE
PLAN CHECKED BY
BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑
OF EDMON DS. LOCAL SALES TAX
e /
BUILDING
SIGN
[o
W PROPOSED USE
SHOULD BE CODED 31.04. _
ADD
b0
(, f. '
RETAINING
WALLEl
REMARKS
nGM— /17S
PLOT PLAN (Indicate Bullding setbacks, abutting streets)
DEMOLISH
A169—r—
A169—r—/•
U� /
ALTER
❑ OR EXCAVATE
❑
I_ x .......... Ft.)
REPAIR
PRE -MOVE
SWIM
RETAINING WALL
INSP. L_j POOLI
NUAIBEII OF STORIES NUMBER OF
DWELLING
UNITS
NA won K BE DOVE
Valuation
FCC Re.clpt Na,
(/nE,O,Fr�
"tom r '
Plan Check N. .....................
�'
e /
BUILDING
[o
W PROPOSED USE
PLUMBING
b0
(, f. '
PLOT PLAN (Indicate Bullding setbacks, abutting streets)
HEAT @ GAS LINE
9
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DMICLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowlsdge that I haus read this apoll-thm: that the fn-
l7V
formation given Is correct; and that I am the owner, or the duly author-
Ired agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
TINS rERMIT
This application is not a permit until.
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
_.
NOTE: Permit Limit One Year (Except DEMOLITIONS winch
ONLY THE
ut and fees are paid, and receipt is ac-
Y� p
shall ba completed In ninety days; MOVED -IN BUILDINGS shall be win•
WORK NOTED
knowledged in apace provided.
pleted In Ix mon t.)
BION •' (O OR ADEN )
DATE SIGNED
INSPECTION
DIRECTOR'S e A URE
DEPARTMENT
CITY OF
EDMOND$
DAfE
NOTE: Applicant S jerl to Plan Check Fee
775-2525
This Permit coven work to be done on private property ONLY.
.any rnnstrucliou pn ibc public dumntn Icurbn, nldewnike, drlyeway°'
PILE
,r,turr., rt c.,.Ilt r,"tnl r• nein rnt,• prrml.slnn.
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