840304.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I NAME (OR NAME OF BUSINESS)
Ira S ri n
�---- i MAILING ADDRESS
0 18819 Olympic View Drive
NUMBER
USE PERMIT /�
ZONE NUMBER {�YYJJj/I.0304
JOB '"''�� �Y
ADDRESS 18819 Olympic View Drive
-EGAL DESCRIPTION CHECK SUBDIVISION NO. LID (40.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING_.__. REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED,.'
SEE ENGINEERING MEMO DATED _ .
SEE PIW DEPT. REVIEW CHECK LIST DATED_-_____— ----- -----
STATE LICENSE NUMBER CITY LICENSE NUMBER
223-01-OLDSO-317-BO
I
SIGN AREA ENV. REVIEW
ADD NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements
(show below or attach tour copies)
I
SHORELINE 0
VARIANCE CR CU PLANNING REVIEW BY
OATE
YARDS
LOT COVERAGE ?
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FRONT SIDE REAR
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S
REMARKS
❑ M
❑
NEW RESIDENTIAL
PLUMBING
❑ ❑
❑
ADD/ALTER NON-RESIDENTIAL
MECHANICAL
❑ ❑
❑
REPAIR RETAINING WALL
SIGN
EXCAVATE
FENCE
❑
CHECKED BY TYP OF CONSTRUCTION CODE
HEIGHT
❑ DEMOLISH ❑ OR FILL
I_x_Fp
❑
SPECIA INSPECTOfl AREA
OC
ElCOMPLOIANCESNSP.
POOL
REQUIRED GROUPOCCLIANGY
LOCADUPANT
❑ SIDE SEWER ❑ WATER LINE
❑
I_) YES :: NO
REMARKS
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p
.NUMBER OF STORIES NUMBER OF
UWtLLI NU
UN"
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Asphalt Paving and grading
PLAID CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
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
successors in interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
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
lion Insurance.
INSPECTION
SIGNA URE (OWNER OR AGENT(
DEPARTMENT
L:�
CITY OF
�jy(
EDMONDS
ATTENTION
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.
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ORIGINAL = File YELLOW — Inspector U
PINK — Owner GOLD — Assessor
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.
F AL'S SIGNATURE _ - I
j`.
RECORD OF INSPECTIONS
�at�e Fay ed '�
CITY OF EDMOND$
BLDG. DEPL
CONDITIONAL' PERMIII
.
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WORK;
ADDRESS;
OWNER
APPROVEDDATE.
BY
BLDG. OFFICI'
AL
KEEP THESE STAMPED
PLANS ON JOSSITE.F.OR
ALL INSPECTIONS
PERMIT. NO.
SHEE'L .
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