750019.pdfNAME
W
ADDRESS
.t CITY I TEL -P IONF NUMBFI
C ADDREdd
C CITY TELEPHONE NUMBI
O STATE LICENSE NUMBER CITY LICENHE Imo• UM
Legal Dr.elfhl]on of Property (Show BeluW or Attach Four Coble;
11 YER [I NO PERMIT NUMBER
PLANNING I EP 'APP V L L—/7--7
7— TE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. W
RF.MAnKB G
S
W
CHECKED BY
EXrsTiA4 -
i
Nl1AIULlt OF HTORIF:H NUMBER OF
• 1
DWELLING
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Ci
UNITS
NA'rURN OgjVORIC TO BF, DONE
PLRC. TEST
PERMIT NUMBER
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BUILDING
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Y
PLUMBING
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1'lAr `•I.AN (Indicate Building setbacks, abutting etrceta)
HEAT & GAS LINE
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FENCE
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MARK.
SIGN
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BUILDING DEPARTMENT AppHeant Fill-�j
PERMIT APPLICATION Inside Heavy Linen
ZONE NUMBIER 750019
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ADDRESS N (�
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Pik c ry
NAME (OR NAME OF BUSINESS)
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y' �•f� Gd /V �OU J
PEItM1Htl E 7 LOTU J
I.OT COVERAOF. y LOT C RAOE Ill/
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MAILING ADDRESS
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IIEItA11tlSIBLE fl; IIT ROPOBED H OHT
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PRE -MOVE INSPECTION
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CITY
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E P1 O�Ti H0 NEl13B '1�{
ACTUAL O AIiEA�
TOTAL BLDG. �.iRlilty
a
-
• 1 hereby acknowied ge that I h-. -ad 161e appticallan; that the In -
tE QU111ED "All.. PROPOS D YARDd a'
NAME
W
ADDRESS
.t CITY I TEL -P IONF NUMBFI
C ADDREdd
C CITY TELEPHONE NUMBI
O STATE LICENSE NUMBER CITY LICENHE Imo• UM
Legal Dr.elfhl]on of Property (Show BeluW or Attach Four Coble;
11 YER [I NO PERMIT NUMBER
PLANNING I EP 'APP V L L—/7--7
7— TE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. W
RF.MAnKB G
S
W
CHECKED BY
EXrsTiA4 -
Oil PILL( .......... ........... Ft.)
REPAIR ❑ PRI: MOV. SWIM
INRI•. ❑ POOL
i
Nl1AIULlt OF HTORIF:H NUMBER OF
• 1
DWELLING
I
UNITS
NA'rURN OgjVORIC TO BF, DONE
PLRC. TEST
PERMIT NUMBER
C
f
W
�
-
BUILDING
rnoPodED uRE
Y
PLUMBING
l3�
1'lAr `•I.AN (Indicate Building setbacks, abutting etrceta)
HEAT & GAS LINE
I
)
FENCE
4
MARK.
SIGN
„t- Pl��'I7"5-'IJ
RETAINING WALL
Pik c ry
paT� I-2. =
DEM1[OLITION
PRE -MOVE INSPECTION
.)
FIRE $py/E TYP�P�
CONST UCT10N STREET 11111111
❑ YES C3 NO
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a
• 1 hereby acknowied ge that I h-. -ad 161e appticallan; that the In -
SPECIAL INSPECTOR REQUIRED
❑YES NO
OCCUPA�jLZOROUP
I t1
ized agent of the owner. I agree to comply with city and elate laws regu.
le ting construction; and in doing the work authorized thereby, no person
NEW
®
IlI1IHD..TIAL
❑ LINE
AUTHORIZES
OTE: Permit Limit One Year (Except DEMOTIONS
NR which
PLAN CHECKED DY
THIS SITE IS LOCATED IN THE CITY
OF ED BE CODED 3A 04 SALES TAR
WORK NOTED
Pleted In sig months.)
NON -...I 0 SIGN
®
SIGNATURE (OWNER OR AGENT) DAT- SID
INSPECTION
ADD
DEPARTMENT
��GNE
RETAINING
WALL
REMARKS
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NOTE: Applicant Subject to Plan Check Fee
A1.7'Fnl
775-2525
EXCAVIelI
EXCAVATE
FENCE
,�.` k)64e
� (J& um
Oil PILL( .......... ........... Ft.)
REPAIR ❑ PRI: MOV. SWIM
INRI•. ❑ POOL
Nl1AIULlt OF HTORIF:H NUMBER OF
DWELLING
I
UNITS
NA'rURN OgjVORIC TO BF, DONE
Pian Check No .....................
0
BUILDING
rnoPodED uRE
Y
PLUMBING
l3�
1'lAr `•I.AN (Indicate Building setbacks, abutting etrceta)
HEAT & GAS LINE
b
FENCE
4
SIGN
„t- Pl��'I7"5-'IJ
RETAINING WALL
BMMA[ING POOL
DEM1[OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
a
• 1 hereby acknowied ge that I h-. -ad 161e appticallan; that the In -
TOTAL AMOUNT DUE
formation given Is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with city and elate laws regu.
le ting construction; and in doing the work authorized thereby, no person
ATTENTION
will be employed In violation at Ne Lohor Code of the State of Washington
TIDE PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
OTE: Permit Limit One Year (Except DEMOTIONS
NR which
ONLY THE
shall be completed In ninety days; MOVED -3N HOILDIDINGe Shall be com-
WORK NOTED
Pleted In sig months.)
SIGNATURE (OWNER OR AGENT) DAT- SID
INSPECTION
DEPARTMENT
��GNE
CITY OF
EDMOND$
NOTE: Applicant Subject to Plan Check Fee
This Permit a s'en work to be don oa prh'ate property ONLY.
775-2525
Any eanelruct"it at lbs PShtic domain (curbs, elde=.., driveways,
eo.v, n, r.. rlc.l was n•gntrr ..Pnrntr p,•rm],,Jan.
Valuation
01cCry
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,
DIRECT 'B t�
FILE
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RECORD OF INSPECTIONS
,
Date Passed
Foundation / -�✓' 7S _
Plumbing (Partial)
(Rouph)
Frame ; 7,)
Furnace & Fuel Lined-Z-1•
y
Final 7- 7J
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