900393.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF ,b ESS
MAILING
ZIP
TELEPHONE NUM13ER
72
HONE NUMBER
USE PERMIT
ZONE OC�1� NUMBER
JOB %�Zwr-r-C� o OLY�?P/G 111eW
ADDRESS
..�.....,,.,t,A u cuanivlSlON NO. LID NO.
TESCP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
ADDRESS METER SIZE BUILDING SUPPLY SIZE FIXTURE
CITY ZIP TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER SIGN AREA ENV. REVIEW
ALLOWED PROPOSED COMPLETE EXEMPT
(shoal w belowporoan of Pr t ach two copiesert jinclude all easements
VARIANCE OR CU PLANNING REVIEW BY
HEIGHT
SETBACKS —FEET
FRONT SIDE REAR
i REMARKS
Tax Account Parcel No.
LJ ::WIALTER
IJ RESIDENTIAL
COMMERCIAL
APT.BLDG.
❑ REPAIR
EXCAVATE, FILL
DEMOLISH OR GRADE
CARPORT
REMODEL GARAGE
DWOOD STOVE ❑ RETAINING WALL/
INSERT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLI
LJ PLUMBING
�n MECHANICAL
ElSIGN
❑FENCE
( x _FT)
r-'i SWIM
NUMBER OF STORIES 1 NUMBER OF
IDWELLING
UNITS
NATUR�E.iF WORK TO BE D%NE (A ACH PLOT PLAN)
11 RENEWAL
Plan Check No.
This Permit covers work tc 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
successos in nd and hold
harmlessr
rthe ICity eof Edmonds,sts agrees to inWashington, feits officials,
Llimit
and agents from any and all claims for damages of
ature, arising directly or indirectly from the Issuance
mit. Issuance of this permit shall not be deemed to
ive or reduce any requirement of any city ordinance
any way the City's ability to enforce any ordinance
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-
tion Insurance. �T� cl! NFf1
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See
PECIAL INSPECTOR AREA OCCUR
GROUP
REQUIRED
0 YES L: NO
R
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ADB No.
SHORELINE M
DAT
�lv 4 /,
LOT COVERAGE
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
M.,MM�
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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,
102.87
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
CALL FOR
INSPECTION
771-3202
EE
41
OCCUPANT
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APPLICATION APPROVAL
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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.
E
BY:
DATE
ORIGINAL — File YELLO — nspector
PINK — Owner GOLD — Assessor
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APR 101990
PERMIT COUNTER
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OWNERoAKI al
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0y�1fja 15 a :KEEL YHESE STAMPED
PLAN ON JOBSITE FOR
'� �`,� y�aPacoaS j `• .ALL INSPECTIONS
PERMIT N0. SHEET
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OF IN
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d4w . INSPECTOR DATE APPROVED
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,.. SETBACKS
FOUNDATIONif I: . r7
_Footing:...::::.:...... a, {:i±
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Wall.... ...... ....... _. h'k
_..., Pier/Porch ............. ..:,
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Retaining Wall. - •.., ...? M'y
.. . .. "
_ PLUMBING..fIII "I
Y
Underground ..........
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t Rou90-lnc,,o o ...
CF.................... _ _..
;. HEATING:
a - • If
Gas Test... .
.. _ .. ._.
Gas Piping ...::...... .
5 Equipment .............
CF..........:.........
FRAMING :......:....:..
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SHEETROCK NAILING f "
SPECIAL INSPECTION :..
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FINAL APPROVAL
FOR OCCUPANCY ......
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