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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICIATION
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PUAN CHECK NO: ESTEO DATE
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THIS PERMIT AUTHORIZES ONLY THE Wo RK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERWIssloN. SURCHARGE
PERMIT APPLIC al N: 1813 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED wooRK. STARTED WITHIN 1W DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR NOIRE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
CITY OF
ENG. INSPECTION FEE
;APPLICANT.
N INTE EST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE
ECMON(R)S. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
MADE OFWHATEVER NATURE. ARISING DIRECTLY OR INDI RECTLY
ALICLAIMIFORO MADE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT I SSUANCE OF THIS PERMIT SHALL NOT BE
PLAIN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR RED U E ANY REQUIREMENT OF ANY CITY ORDINANCE
PROVISID
IIPTI_5�
SA Y
NORLIMIT INANYWAY THE CITY RILIT TO ENFORCE ANY ORDNANCE
TOTAL AMOUNT DUE
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LHERE ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
By
APPLI AT
GIVEN IS CORRECT AND THAT A. THE OWNER. oNATTEE DULY.AUTH0Tl'l.l.E D AGENT OF
,, � 1 -1.1 1.,ld by thl
THE OWNER. I AGREE TO COMPLY WITH CITY AND LAWS E.U' CONSTRUC
CALL
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TION.ANDIN DOING THE WORK AUTHORIZED THEREBY. NoPERSONYALLBE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
ll� 1.dged � �p p,—d-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
AND RGW 18.21.
IALS SIGNATURE D TE
WORKMEN S COMPENSATION INSURANCE
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SIGNATURE (OWNER OR BE DATE �IGNIED
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UL -
771-0220
REL SEDBY E
EXT 333
ATTEOtION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
oRiGINAL - FILE . YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -ASSESSOR
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RUG-11-2600 12113:48 i4ESCO GRS SCHEDULING 206 378 6604 -P.04
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Energy sewes'lEEW
UC, No. WASHIES07403
Date: Friday, August 11, 2000
Dear: GLENNFORREST
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23700 102ND PL W
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EDMONDS,WA 98020
Several months have passed since Washington Energy Services has completed the appliance
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installation at your home. We would like to take this opportunity to thank you for your business and hope
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your appliance installation is working properly and efficiently.
According to our records, your permits have not received a final inspection. Ifour records are
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incorrect and there is a signature from an inspector at the bottom of the permit(s), please contact
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Walters at 1-800-3984663, extension 6632 so that we may update our records. Ifyour inspection has not
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been completed, please contact Ms. Walters to set up an inspection date. Please be advised that the law
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requires permits and inspections for all gas appliance installations. One of the most important reasons for
homeowner, that the
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This requirement is customer safety. Receiving a final inspection assures you, the
entire installation meets the safety codes set by the city, county and or state agencies.
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Ifyour permit inspection is not complete, please contact Ms. Walters at The telephone number
listed above. She will coordinate with the Inspection Department a date for the inspection. This inspection
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will require a phone call, by you, to your designated inspector between 7:00 — 8:00 A.M. an the morning of
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your inspection. This contact is to confirm that you are on the inspector's schedule as well as secure
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more specific time for your inspecti on on that day. Ms. Walters will provide you with the appropriate
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phone number upon receipt ofyour all. Your presence is required at your home on die day of the
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inspection. If you are unable to be present on the day of the inspection, you may designate an authorized
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agent (eighteen years or older) to allow access to your home for the inspection.
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We believe completing the permit process required by our municipalities is in the best interest of
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ou, customers. It is also important for our customers to know what impact the permit process may
potentially have, should the inspection not be completed and signed off. Ifyou do not follow through with
the inspection procedures, your homeowners insurance is not obligated to cover loss in the event ofa major
installation- related incident. Ifyou intend to sell your home, the lack ofpermit inspection and clearance
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will definitely delay the sale process. In the event the permit expires, you will have to repurchase the
permits and go through the inspection process until diejob meets code requirements. The municipality,
upon verification of non-compliance, does have die right to turn the gas off at its source, thus leaving you
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without the use ofyour installed appliances.
0 at customers are important to us! It is our intent to keep you in formed of all maj or requirements
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regar ding your gas product installation. Our responsibility is to provide the safest and highest quality
installation possible. Working together, we can make this happen.
Please contact Maciva Walters at 1-800-398-4663, extension 6632 ifyour inspection has not been
completed.
�Mitc �Pes.., VP Operations
Corporate Office: 2800 Thorndyke Avenue West Seattle, WA 98199
Ph (206) 282-4700 - Fx (206) 378-6600 - (800) 39&HOME www.washingionenergy.com
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ............
wall...................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in
...............
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commercial Final
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HEATING:
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Gas Test ....................
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Piping
Gas .................
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Equipment .............
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ..................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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DATE PECEIV::� P RMIT EX01
us PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTN
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REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAMAGE
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ADDIT OMMERCIAL C MPLIANCE R
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THIS PERMIT AUTHORIZES ONLYTHEWO RK NOTED. THIS PERMIT CO�ERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUG
(CURBS. SIDEWALKS. DRI TWAYS, MARQUEES, ETC.) WILL REQUIR
DOMAIN VF
SEPARATE PERMISSION.
GRADINGIFILL
SURCHARGE
as ,PEAMITAPPLICATiONz 18 0 DAYS
PERMIT LIMIT-. I AR - PROVIDED WORK IS STARTED WITHIN 181) DAYS
SIECBAC K OF PINK PERMIT FOR MORE INFORMATION
ENG, REVEV�rFEES
P HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
A PLICANT, ON BEHAL OF
sa N I NTERESt, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I
w EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
4 ALLCILALMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERM" ISSUANCE OF THIS PERMIT SHALL NOT 8'
C CE ANY PEOUIAEMENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY, WAIVE OR REDU
0 NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
ENG. INSPECTION FEE
114SPECTION FEE
Ft CEIPT
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN I S CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORI ED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
TION. AND IN 00 NO THE WORK AUJ HORIZED THEREBY. NO PERSON WILL BE EMPLOY `
0
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKM5N'S COMPENSATION INSURANCE AND RCW 18.27,
SIGNATURE (OWNE10 GEN IGNED
APPLICATION APPROVAL
TIal paina-, - a pIllit Iltil ligIld bal Ih,
CALL 8 Official a, h .,D. ty::.d Foes am pasd. sad
90 -PI .k`,a,)adg P... p-m.d.
FOR INSPECTION 4
(425)
771-0220 EL BED BY f
'ATTENtION EXT333 ------
T IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FIN AL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFl- FAX 111111AL-FIll YELL :.PE.C�T.
HAS BEEN GRANTED. UBC SECTION 109 PINK OWNEI�XA�S
CATE OF OCCUPANCY