930351.pdfZONE
PERMIT
CITY OF EDMONDS ZONE NUMBER 930351
CONSTRUCTION PERMIT APPLICATION joa _ SUITE/APTtt
OWNER NAME/NAME OF BUSINESS ADDRESS \ `CAe
GRANT BUSH LEGAL DESCRIPTION CHECK SUBDIVISION NO LID NO.
w MAILING ADDRESS
Z
0 1 931 5 OLYMPIC VIEW DRIVE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
CITY ZIP TELEPHONE NUMBER RW Permit Required ❑
EDMONDS 98026 7 7 6- 61 3 7 EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
1 1 Inspection Required ❑
PROPOSED
NAME Sidewalk Required ❑ 0
z
REMARKS iE
w
w
w ADDRESS Z
F Z
Z
= w
U
a CITY ZIP TELEPHONE NUMBER
NAME
GAS APPLIANCE SERVICE, INC ENGINEERING MEMO DATED REVIEWBY
ADDRESS
o1 1 0 3 NORTH 3 6 TH ST METER SIZE BUILDING SUPPLY SIZE NO. OF FIXTURES
z
CITY
98103 ZIP TELEPHONE NUMBER 0 0 0 REMARKS w
a
0 3
U STATE LICENSE NUMBER EXPIRATION DATE
GASAP I * 3 71 NT 9/1 / 9 3 SIGN AREA SEPA REVIEW ADB NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE M
Z
O EXP
t-
Q. VARIANCE OR CU PLANNING REVIEW BY DATE
s
U
V)
w U
SETBACKS — FEET HEIGHT LOT COVERAGE Z
J Z
FRONT SIDE REAR Z
Property Tax Account 434600008604 REMARKS ga
Parcel No.El
NEW L1jJ RESIDENTIAL ^® PLUMBING
n� ADDITION D COMMERCIAL Imo: MECHANICAL
J REMODEL El APT. BLDG. El SIGN
1 GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
REPAIR CJ CYDS, ( X_FT) J��/�'�'1 1
DEMOLISH El NSERTTOVE HOT TPOOL UB SPA SPECIAL INSPECTOR AREA ! OCCUPANCY OCCUPANT
REQUIRED YES GROUP LOAD
F GARAGE RETAININGCARPORT ROCKERY WALL/ a RENEWAL REMARKS
C7
O (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 3O5 25
Z
¢RESIDENCE m
w NUMBER NUMBER OF CRITICAL
o OF DWELLING AREAS
m STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
INSTALL PAYNE 399AAV488 LUS90 GASto 2 FINAL INSPECTION REQUIRED
RELOCATE/INSTALL STATE WATER HEATER VALUATION FEE
rVIUVE TO UARAUE, 10 cmb PLAN CHECK FEE
& 10' H&C PLUMBING
BUILDING
HEAT SOURCE: GLAZING
PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done 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
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Within 180 Days .
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
N successors in interest, agrees to indemnify, defend and hold J\
J 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 PLAN CHECK DEPOSIT
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 TOTAL AMOUNT DUE
provision."
provision.
hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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 THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor WORK THE
D Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa• acknowledged in space provided.
tion Insurance. INSPECTION
SIGNATU E R AGENT) DATE SI ED DEPARTMENT
CITY OF OFF I SiSIG VuRE DATE
EDMONDS
CALL FOR
RELEASED BY: DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE l
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector
r
A CERTIFICATE OF OCCUPANCY HA5 BEEN GRAN I Eu. uoU 01
CHAPTER 3. PINK — Owner GOLD — Assessor.'.
102-87 0