870011.pdf■ i
=MoriUSE PERMIT
CITY OF EDMONDS ZONE NUMBER 810011
CONSTRUCTION PERMIT APPLICATION JOB q r
NAME (OR NAME OF BUSINESS)lyeADDRESS �� I C ��� � Vim/
E� ^/ Re Re LEGAL DESC1111RIPTION CHECK SUBDIVI ON NO. LID NO.
ZMAILING ADDRESS '\' eeeft
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
�' O/ /)7U Al C7 S ~D D ' " C7 PRIS
OPOSED REQUIRED DEDICATION Z
NAME Cr
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑ i
�- STREET USE PERMIT REQUIRED ❑
W ADDRESS w
T SEE ENGINEERING MEMO DATED
NAME
METER SIZE BUILDING SUPPLY SIZE r ixiur+t
CITY TELEPHONE NUMBER
MINEEME
REMARKS
STATE LICENSE NUMBER
SIGN AREA ENV, REVIEW
MW
ALLOWED I PROPOSED COMPLETE I EXEMPT
Legal Description of Property - Include all easements
rehow below or attach four copies)
VARIANCE OR CU
YARDS
TT /
FRONT SIDE w
NEW RESIDENTIAL ❑ PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR L RETAINING WALL ❑ SIGN
ElEXCAVADEMOLISH OR FILLTE ❑ l ENCE x—FT)
PRE-MOVE
REMODEL Cl COMPLIANCE SINSP. POOL
❑ WOOINSERT ❑ APT. BLDG RENEWAL
NUMBER OF STORIES NUMBER OF '
DWELLING
UNITS
)31 NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
*dn,This Permit covers work to n private property ONLY.
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
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authorize
ed thereby, no person will be employed In violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
IATURE (OWNER OR AGENT) DATE
(4% '*e* , /_0 62 4k.
BY ITY
REQUIRED
O YES ❑ NO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
REVIEW BY
ADB NO.
DATE
HEIGHT JLOTCOVERAG
REAR' 25 �G b
iJ TXd
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771.3202
GROUP
VALUATIO
OCCUPANT
LOAD
aco 16
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'rS SIGNATURE DATE
RELEASED BY:
DATE
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.
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
l �C-, IFle
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CITY OF EDMONDS
250 51h AVE. N. EDMONDS, WASHINGTON 98020 (206) 771.3202
COMMUNITY SERVICES
January 6, 1987
R. Kean
18910 Olympic View Drive
Edmonds, WA 98020
PERMIT NUMBER: 850261
i
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
Building Division records Dermittwhichthat
hasuexpiredbeen
withoutafinal
notified of your building p
inspection. Section 305 of the Uniform Building Code, as adopted by
the City, states, "it shall be the dutyof
Officialerson athat suchthe work
ork
authorized by a permit to notify the Building
is ready for inspection...there shall be a final inspection and
approval on all buildings and structures when completed and ready for
occupancy or use.
Please notify the Building Division within 15 days date of this letter
se
to schedule for a final inspection• If we do matternot overetoltheelve aOfficenof
from you we will be forced to turn this
the City Attorney.
0000
eannine L• Graf
Permit Coordinator
JLG/dmc
ORKS PLANNING •
PARKS AND RECREATION ENGINEERING
PUBLIC W
Mn �iA
r
71r..:• roy „�
S
r r-
n
•
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-I
It l
It
It
,y
,
t
y � �
,RECORD OF INSPECTIONS
Date Passed
FOUNDATION
House
FINAL APPROVAL GIVEN BY:
-Initials I Date
Building I.
Fire Dept.
Planning (ADB)
Engineering
Porches, piers • --•-
Retaining walls
Garage. carport
PLUMBING
Underground
Rough•in
Water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL.