890566.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
unU AUUMCJO
TELEPHONE NUMBEI
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NAME C 0� 77 A C p
ADDRESS
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CITY TELEPHONE NUMBER
STATE LICENSE NUMBER
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Legal Description of Property - include all easements
(show below or attach two copies)
I t 5r/ • oa#�005r -0003
LA NEW LQI RESIDENTIAL
ADDIALTER D COMMERCIAL
REPAIR
APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL El GARAGE
WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY
PLUMBING
(� MECHANICAL
L_.J SIGN
FFENCE
( x _FT)
rt SWIM
RENEWAL
NUMBER OF STORIES I NUMBER OF '
�— DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
S/n/G L E deio /641/1W y' 13
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.
USE PERMIT
ZONE j� NUMBER
JOB �•J�
ADDRESS
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Worls 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 authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa•
NATUM WNER O ENT) DATE SIG ED
ATTENTION
EGAL DESCRIPT N CHECKISUPVISION
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING _ REQUIRED DEDICATION _�.--
PROPOSED —ev—._
RIGHT OF WAY CONSTRUCTION PERMIT REOUI
STREET USE PERMIT REQUIRED .
SEE ENGINEERING MEMO DATED
L
Mir
TESCP
APPROVED BY
SIGN
AREA
ENV,
REVIEW
ALLOWED
I PROPOSED I
COMPLETE
I EXEMPT
VARIANCE OR CU IPLANNJNG REVIEVI BY
SETBACKS — FEET HEIGHTI I LOT
FRONT LS "SIDE to REAR Z51 Zv'
A
;,NECKED BY TYPE OF CONSTHUGTIUN wuc
ADM` 943�
SPECIAL INSPECTOR AREA OCCUPANCY
��
REQUIRED GROUP
n YES ; : NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
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
771-32Qj
PLQVL
11
HEIGHT
Z5
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.
OFFICIAL'S SI
ft
191s14
ORIGINAL w e YELLOW — Inspector
PINK — Owner GOLD — Assessor
L
� I
8000
M
i Y
• n c
_ o
OLYMPIC VIEW DRIVE a
r
�• ��
Date Sent to Engineering
ENGINEERING APPROVAL FOR OCCUPANCY
MEMO T0: Permit Coordinator
Building Division
FROM:
DATE:
Dan Smith Inspector
Engineering
SUBJECT ADDRESS:
SUBJECT NAME:
I, A
PERMIT APPROVED FOR FINAL
II.0 PERMIT NOT APPROVED FOR FINAL
Requirements:
1.
2.
3.
4.
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RECORD OF INSPECTIONS
Ah
ECTIO----
,pp42 �`/M�' �rr�m
FOUNDATION
House
Porches, pii
Retaining w
Garage, carl
PLUMBING
Undergroun
Rough -in
Water servic
HEATING SYSTI
FRAMING
WALLBOARD
FINAL.
S7os60000
6