840302.pdfUSE
- CITY OF EDMONDS ZONE NUMBER Q^( 2fLµ
CONSTRUCTION PERMIT APPLICATION JOB Cil1 i3 Li'J
I NAME (OP NAME OF BUSINESSI ADDRESS 18823 Olympic View Drive
H. J. Seaborg LEGAL DESCRIPTION CHECK SUBDIVISION NO, LID IJO.
-- w MAILING ADDRESS
0 18823 Olympic View Drive
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
Edmonds WA EXISTING__REQUIRED DEDICATION
PROPOSED
NAME
H RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED LI
w ADDRESS STREET USE PERMIT REQUIRED
H
SEE ENGINEERING MEMO DATED.._. _.._..
CITY ITELEPHONE NUMBER 11 SEE PIW DEPT. REVIEW CHECK LIST DATED_ _
Olds Olympic Inc
UP;"ADDRESS
P.O. Box 180
METER SIZE
_' B LDING SUPPLY SIZE FIXTURE UNITS
CITY TELEPHONE NUMBER
Lynnwood, WA 98036 778-3124
REMARKS
STATE LICENSE NUMBER CITY LICENSE NUMBER
SIGN
AREA ENV. REVIEW Ace NO.
Legal Description of Property • Include all easements
ALLOWED
PROPOSED COMPLETE EXEMPT
(show below or attach four copies)
SHORELINE p
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS
LOT COVERAGE
I.
FRONT
SIDE REAR
REMARKS
NEW ® RESIDENTIAL El PLUMBING
ADD/ALTER NON-RESIDENTIAL 11 MECHANICAL
El
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
CHECKED BY
TYPE OF CONSTRUCTION CODE HEIGHT
DEMOLISH OR FILL I_XFTI
I
❑PRE -MOVE INSP.f ❑ SWIM
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP. POOL
REQUIRED
GROUP LOAD
I YES
REMARK
'. NO
SIDE SEWER WATER LINE
NUMBER OF STORIES NUMRFFIOF
UWtLLINU
�J--
UNIIJ
NATURE OF WORK TO BE DONE (ATTACH PLOT PLANI
ASDhalt Pavina
CHECK FEE
ING
BING
[LA
ANICAL
This Permit covers work to be done on private property ONLY.INGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
y successors in interest, agrees to Indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
�LCd�IC'
5 employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to
9 modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
I lon.tasurance.
INSPECTION
SIG JATUR WNER OR AGENT) S NEO
DEPARTMENT
JnATE
CITY OF
�(/lxl
EDMONDS
ATTENTION
771.3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED,
UBC
CHAPTER 3.
102 76
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt Is
acknowledged In space provided.
(, 3
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS
Date Passed
FOUNDATION
House
Porches, piers
Retaining wails
Gdrage, carport
PLUMBING
Underground
Rough -in
Water service
HEATING SYSTEM
r;
t
FRAMING
WALLBOARD
s
FINAL
Elly OF EDMONDS
G. i�FPT'
BLDG.
GONDITIONAL..PERMIT,
WORK-
e
OWNER,
APPROVED.DATE,
.
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BY:
FLDG.'OFFICIAI
KEEP THESE STAMPED
,
PLANS ON J06SITE FOR
e
'
ALL INSPECTIONS
`— SHEET_,.:
PERMIT
I OF.
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