860589.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
tqw C.
.. ADDRESS
'40 .
E NUMBER
USE 4_
ZONE
JOB j
ADDRESS
PERMIT
NUMBER
e4lc Y��✓,D,��F,F
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
IREM7
TER SIZE
CITY TELEPHONE NUMBE
STATE LICENSE NUMBER
S
Legal Description of Property • Include all easementsALLOWED
a sIIOA7 '
A16 ,.
W
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913)0X00019 A►Jb iM •-IJ n 41) 31o2 019
NEW LRESIDENTIAL 1:1 PLUMBING
ADDIALTERMMERCIAL MECHANICAL
REPAIR RETAINING WALL SIGN
DEMOLISH ORCFILLTE FE( NCE xFT)
❑ PRE -MOVE INSP.I ❑ SWIM
REMODEL COMPLIANCE INSP. POOL
WOOD
INSERT
1❑ APT. BLDG El RENEWAL
NUMBER OF STORIES
NATURE OF WORK
NUMBER OF
DWELLING
UNITSIIN6
SUPPLY SIZE
AREA
I PROPOSED
VARIANCE OR CU
ENV, REVIEW
COMPLETE EXEMPT
LANNING REVIEW BY
YARDS
FRONT Z7
✓w�l SIDE �t� I REAR25w
3HECKED BY TYPE OF CONSTRUCTION
SPECIAL INSPECTOR AREA OCCUR
REQUIRED . / GROUP
❑ YES O
/ PLAN CHECK FEE
G0i70 "0 41ydf,�TA/4 S - BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be don6 on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days ENERGY CODE
Permit Limit: 1 Year, Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns anck
successors in interest, agrees to Indemnify, d fend 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 PLAN CHECK DEPOSIT
I 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
In formation 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
tion Insurance. INSPECTION
SIGNATURE (OWNER OR AGENT) IDATE SIGNED , DEPARTMENT
M
7//d(//9'6
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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CITY OF
EDMONDS
771.3202
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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.
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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CITY OF EDMONDS
250 5th AVE. N. EDMONDS, WASHINGTON 96020 (206) 771.3202
COMMUNITY SERVICES
August 7, 1987
Thomas Mathews
1432 Olympic View Drive
Edmonds, Washington 98020
RE: Permit #860589
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
According to building division records the subject permit is due to
expire on September 3rd. Prior to that time the building division must
either grant a final approval on your project or if there is more work
to be done you must renew the permit.
Please contact the building division with regard to your intentions, at
771-3202.
Thank you,
Jeannine L. Graf
Permit Coordinator
PUBLIC WORKS
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FINAL APPROV L GIVEN BY: - ,
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RECORD OF INSPECTIONS y
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ZONE Date Passed ;
SETBACKS: �'ouNDATION,
F"Q NT House
Porches; piers
SIDE
Retaining walls
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Garage, carport.,OTI LNUMBING
HEICFlTUnderground
Rough•in,
Water service
HEATING SYSTEM
FRAMING !
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