750175.pdfPlan Check No .....................
Valuation
Fee R-1pt No.
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will be employed In violation of the Labor Cade of the State of Wesbington
THIS PERMIT
relating to Workmen'a Compensation Insurance.
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THE
ONLY WORK NOTEOTE D
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com
us PERMIT
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DEPARTMENT
Applicant Fill
DEPARTMENT
CITY OF
APPLICAT
inside ley Lines
ADDRESSISI I/
NOTE: Applicant Subject to Plan Check Fee
NAME (OR NAME OF DUS1NEtle)
This Permit raven work to be done on private DONLY.
Any eon'tructlon on the publicdomain (curbs, eldew.Jk., dks, d rlreways,
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marquees, etc.) will require separate perml.slon.
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PEUMIStl E ATIA"
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i'EKAiHtlIBLE kFIORT PROPOSED HEIGHT
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CITY
T ELEPHONE NUMDER
ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YAItUtl PROPOSED YAItUtl
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NAME
FRONT SIDE REAR FRONT tliD- REAR
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ADDRESS
LEGAL LOT VAR ANC- OR CONDITIONAL USE
NUMBER
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER
STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAMEy
COMP. PLAN ST. R/W ............FT. ............FC.
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REMARKS
REMARKS
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CHECKED BY
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TELEPHONE NUMBER
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METER BIZ- SERVICE SIZE CLEARANCE
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CHECKED BY
AT LICENSNUAIBER
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REMARKS
Lesal Descrlptlon of Property (8how Below
or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
YES [] NO
SPECIAL INSPECTOR REQUIRED
GROUP
RESIDENTIAL
GA
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C] YES 0 NO
IOCCUPANCY
NEW
LINE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
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S. LOCAL SALES TAX
ADD
RETAINING
BE
SHED 31.04.
SHOULD BE COD
REMARKS
DEMOLISH
Lj WALT
ALTER
EXCAVATE
J��ry-�(r�PENCE
Fence requirements - section 12.14.040-
❑ On FILL
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ElREPAIR
❑ PRE-.
Elswimattacjed/
NUMBER OF STORIES NUMBER
OF
DWELLING
UNITS
Plan Check No .....................
Valuation
Fee R-1pt No.
•
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[may BUILDING
4 PROPOSED USE
`yl PLUMBING
O
Ized silent or the owner. I agree to comply with city and elate law' regu-
PLOT PLAN (Indicate Building setbacks, abutting street.) HEAT A GAB LINE
h
FENCE
SIGN
i RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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I� O. /,1
�V
will be employed In violation of the Labor Cade of the State of Wesbington
THIS PERMIT
relating to Workmen'a Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
THE
ONLY WORK NOTEOTE D
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 apace provided.
D' TGR'M WGNAT .•+cy� !!:._.,r
DATE
-a-a -77 S" ,✓—
FILE
TOTAL AMOUNT DUE
Ihereby acknowledge that I have read this application; that the In.
formali given Is correct; and thot I am the owner, or the duly author-
Ized silent or the owner. I agree to comply with city and elate law' regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Cade of the State of Wesbington
THIS PERMIT
relating to Workmen'a Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
THE
ONLY WORK NOTEOTE D
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com
plctcd In elx month..)
RGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDbIONDB
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permit raven work to be done on private DONLY.
Any eon'tructlon on the publicdomain (curbs, eldew.Jk., dks, d rlreways,
marquees, etc.) will require separate perml.slon.
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 apace provided.
D' TGR'M WGNAT .•+cy� !!:._.,r
DATE
-a-a -77 S" ,✓—
FILE