840701.pdf- GI,Y OF EDMONDS
I CONSTRUCTION PERMIT APPLICATION
it NAME (OR NAME OF BUSINESS)
Frank Leifer
ZMAILING ADDRESS
0 810 12th Avenue N.
CITY TELEPHONE NUMBER
Edmonds 776-4565
NAME
NAME
Frank Leifer
ADDRESS
810 12th Avenue N.
CITY TELEPHONE NU;
Edmonds 776-4565
STATE LICENSE NUMBER CITY LICENSE NI
r
Lot 3 of S-17-84 Hildebrand/Leifer
Tract 17, Edmonds Seaview Tracts
IFIEMARKS
PERMIT 84070 w
NUMBER 1
S 18927 Olympic View Drive
DESCRIPTION CHECK SUBOWISION NO. L10 r10.
S-17-84
RIGHT OF WAY PER OFFICIAL STREET MAP.
NG___ _.. _._ REQUIRED DEDICATION .... ........ _
SED._.__
z
6
OF WAY CONSTRUCTION PERMIT REQUIRED.
T USE PERMIT REQUIRED z
z
NGINEERING PAFMO DATED_ w
IW DEPT. REVIEW CHECK LIST DATED __.._...._......___..._..___— KS
NEW
I---% RESIDENTIAL
PLUMBING
ADDIALTER
NON-RESIDENTIAL
lU�
LJ MECHANICAL
REPAIR
RETAINING WALL
El SIGN
DEMOLISH
EXCAVATE
OR FILL
❑ iENCE
x_Fn
-MOVE IN%l
❑ SWIM
❑PRE
COMPLIANCE INSP.
POOL
SIDE SEWER El
WATER LINE
NUMBER OF STORIES
NUMBER OF
p DWCLLINU
m U.N..
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Request water meter pulled_
SIGN AREA ENV, REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE OR CU PLANNING REVIEW BY I DATE
YARDS LOT COVERAGE
FBnuT SIDE REAR
CHECKED BY TYPE ur c;urvsl nu�li�n ..�.••
Iqb2
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP f2—� LOAD
❑ YES NO
F I O #L JW s C:—%10 Ia RE-(3-D
Demolition
PLAN 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. m0
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
v, successors in interest, agrees to indemnify, defend and hold
w 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
i 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 ATTENTION
Information given is correct; and that I am the owner, or the duly
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
ad thereby, no person will be employed in violation of the Labor wo LY THE
Code of the State of Washington relating to Workmen's Compensa•
lion Insurance. INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
l r �/�/ CITY OF
/•Z` 2y O / EDMONDS
nl- 202
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.
102 78
25.00
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.
OFFICIAL'S LIGNATURE yy�
\� (.VLO' r r l
DATE
7- 2-4 -64
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor