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[ADDRESS
E PERMIT
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CITY OF EDMONDS NE NUMBER p
CONSTRUCTION PERMIT APPLICATION v�
B
NAME (OR OF BUSINESS) ` ✓ �
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
on of
attac
(UMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
�L EXISTING REQUIRED DEDICATION
PROPOSED
NUMBER
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED Ci
STREET USE PERMIT REQUIRED C
SEE ENGINEERING MEMO DATED
REMARKS
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
TELEPHONE NUMBER
REMARKS
SIGN AREA ENV. REVIEW
include all easements ALLOWED ( PROPOSED COMPLETE I EXEMPT
NEW RESIDENTIAL
ADDIALTER COMMERCIAL
REPAIR RETAINING WALL
❑❑ EXCAVATE
DEMOLISH OR FILL
REMODEL PRE -MOVE INSPJ
COMPLIANCE INSP.
❑ WOOD STOVEI
INSERT APT. BLDG
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
NMI
PLUMBING
� MECHANICAL
n
LJ SIGN
❑FENCE
( x _Fr)
f-1 SWIM
® RENEWAL
This Permit covers work to be done on 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
E 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 authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa•
V
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ATTENTION
VARIANCE OR CU
YARDS
FRONT
REQUIRED
❑ YES
PLANNING REVIEW BY
SIDE REAR
TYPE OF CONSTRRUUCTITION
/ V
GII
DATE
HEIGHT I LOT COVERAGE
/912-
GROUP jp:
PROGRESS INSPECTIONS PER UBC 305
A004416
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
�r��Lza:n
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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•87
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771.3202
TION
ov
OCCUPANT
LOAD
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.
'S SIGNATURF./ DA
RELEASED BY;
TE
ORIGINAL — File YELLOW — Inspector
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PINK — Owner GOLD — Assessor
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LARRY S. NAUGHTEN a<"
CITY O� EOMONDS MAYOR
250 5th AVE. N. EDMONDSr WASHINGTON 98020 • (206) 771.3202 ; „1r4v.
PETER E. HAHN H
COMMUNITY SERVICES DIRECTOR
�r
September 219 1987
f .
Thomas Powell ry':
18427 Olympic View Drive
Edmonds, Washingtall
on 98020
RE: Permit #860787
division records.the subject permit is due to
According to building division must
expire on November 21st•Prior
ontyouraprojectme tor building
flthere is more work
either grant a final approval
to be done you must renew the permito
sion with regard to your intentions, at
Please contact the building divit
771-3202.
i,
Thank you,
Jeannine L. Graf
Permit Coordinator
PUBLIC WORKS
PLANNING ,, _ 4..
PARKS AND RECREATION ENGINEERING
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RECORD
OF
INSPECTIONS
1
Date Passed
FINAL APPROVAL. GIVEN BY:
Initi»is I Date
I
Builc:in� •I.
Fire Dept.
Plnr:. inn (ADB)
Engineering
FOUNDAT
House_•... r.... M .. :`
Porcl-t piers
RItai: irrg walls
G<Ara, :I carport
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