670504.pdfa
BUILDING DEPARTMENT Applicant FM
PERMIT APPLICATION IDO'dHeavy Lines
(OR NAME or DUNN=S)
Co E
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ELEPHONE HUNNNA
9kib">�oAio5 LOAs"I PR8 S7ya.
-tea a t e.:
Mpi p asftliuon of Yropeny tenow imiow or An
RESIDENTIAL OAS
LINE
ElNON-RESIDENTIAL ❑ SIGN
❑RETAINING
DEMOLISH WALL
❑EXCAVATE FENCE
OR FILL (.......... x_........ Ft.)
PRE -MOVE ^ SWIM
INSP. ' { POOL
sty =
C.
STED ON RROLL MAP NO.:
B ADDRESS
.23Im
DE YARD SETBACK( I STREET SET]
I % so
SE ZONE' I LOT MA
C , Q,
COMP,
STREET R/W ............Fire
v .r
PERMIT
N
IP67051
IJ1[BIaR
324 za
ACs REAR YARD e
/se,,,I
0-5
VACANT SITE
n YES o
Valuation Fee Receipt No.
z [1
r 1 Plan check Noe ............... ....
PROPOSEDUSE
6 /V(�P C7 E BUILDING /ts�D.r
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
14
1; N ►—ts S
�+ 041 5 E P c R A r E. HEAT tr GAS LINE
S feet E C—T FENCE
t SIGN
N
RETAINING WALL
SWIM NO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 0
I hereby acknowledge that I have read this application; that the in-
formation given in correct; and that I am the owner, or the duly author
axed agent of the owners I agree to comply with city and state lawn regu. ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorised thereby. no Pena¢
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workman'e Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or hie DeP-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
SIGN T RE (OWNER OR AGENT) DATE SIGNED INSPECTION DIRECTOR'S SIGNATURE
9i y DEPARTMENT
elf/. d ( �% �%L /
OITY OF -
EDMOND9 DAT
NOTE: Applicant Subject to Plan Check Fee
PR 6-1307
This Permit covers work to be done on private property ONLY.
Any construction an the public decants (curbs, aldewaUn, driveways, FILE
marquees, etc.) will require separate permission. s
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