20000925.pdf. �, DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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NAME
FPERMITEXPIRES
PERMIT
ONE J26 NUMBER 60JZ5
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PI.AT NAMEISU13DIVISION NO I LOT NO, "I NO
"D FEE s
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P_` "u"I"
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C, FIXTURES PFV REQUIRED
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OWNEMCONTR' CTOR RESPO FOR EROSION CONTROUDRAINAGE
ICITY ZIP ITEIEP111
NAME
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PROPOSEDS TBACKS(FT)
0 NEW NTIA PLUMBING / MECH
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E] ADDITION C] COMMERCIAL o COMPL ANCE OR
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQIIIRE
SEPARATE PERMISSION.
CHARGE
PERMIT APPLICATI N: i-BOAIS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INF�AMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIF$. ASSIGNS AND SUCCESORS
ENS INSPECTION FEE
RES - AG HE INDEMNIFY DEFEND AND HOL. HARMLESS THE CITY 01
I-N!" T R S To
ANY AND
LANDSCAPING
S E OY EES AND AGENTS FROM
E .. N B S ZHINX�TG ITS F'CIA' MPL
INDIRECTLY
INSPECTION FEE
AL NIS FOR DAMAGE "NO DIRECTLY OR
LC LA OF WHATEVE P NATURE . AR PERMIT SHALL NOT HE
THIS
RECEIPT
A 0" T HE ISSUANCE OF THIS PE. MIT I 'U NO 0,
S Y A E FE.ENT OF ANY CITY ORDINANCE
N REOL,
PLA CHECKDEPOSIT
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BE TO .B"Y . W �E.R - E
EIAED A IE A�Y.RDINANCEPROVISION'
S ABILITY TO EN FORCE
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NOR L�.'T IN ANY WAY THE CITY
TOTAL AMOUNT DUE
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ApT,.C�ATULNY THAT THE INF F.11.N
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER OR G AUTHORIZED AGENT OF
1,-d by lhl
THEOWNEH, I AGREE TO COMPLY WITH CITY AN6 BTATE LAWS REGULATING CONSIRUC
CALL
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7ION AND IN DOING THE WORK AUT ED THEREBY, NO PEAS NWILLBEE.PLOYED
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FOR INSPECTION
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N OLATION OF THE LABOR CODE OF THE E OF WAS-1
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AND ROW 18.27.
0 LS SIGNA URE CA E
WORKMEN S COMPENSATIO,"l SUPPCE
SIGNATURE (OWNE�_ I DATE I'D
(425)
f / 19
DATE
I �
771-0220
RELEASED Y
EXV333
�
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE NTIL
_V��
APPROVAL OR A CE UllFI-
I I I I
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SEC71ON 109
FAX
PINK OWNER GOLD -ASSESSOR
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NETCLERK PRE- REGISTRATION AUTHORIZATION
1, the undersigned, give permission to accept any of the below signatures on a permit
application in lieu of an In -person signature, I hereby certify under the civil penalty of perjury, I
will comply with all declarations and agreements on the permit application.
The following authorized representatives and their employees my pe Ission to
I
sign and take receipt of construction permits In e 0 ompany
JeffJordan
Contractor Name (Type - Print) Contracto�0121&e
Courier Service Name (Type - Print) Courier 8
Scott Waterbury
e 'atul�r'
NetClerk Nam (Type - Print) NetClerk Sign
Undersign
Jeff Jordan
Contractor's me
Fast Water Heter I
Company Name
12601 132"Avenu
Comr)anv Address
WA 98034
Date
Worker's Compensation Insurance Carrier Policy Number
zurich-Indurance Company
WC2978779
City Business License
Expiration Date
City Electrical License
Expiration Date
Contractor's State License No. and Class
Expiration Date
FASTWHCO52DF
12/01/2000
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'P�IE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ITY
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01.�d ZIP
ITEIEP ONE
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ADDRESS
CITY ZIP ITEIEPHOME
NAME
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STATE LI ENSE NUMBER 'TTTIT�o I �cl'
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0 NEW
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C] ADDITION
0 COMPLIANCE OR
CHANGE OF USE
REMODEL
SIGN
REPAIR
GRADING ( F "CE X F7)
DEMOLISH
TANK E] OTHER
GARAGE
0 ARPORT
C
RETAKINIRNVG WALL
RO C C
C] RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPIL,AIN
NUMSER
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PLAT NAMEISUBDIVISION N077 LOT NO. LID NO.
LID FEE S
P E STREET MAP Rw I.— "u",
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EXISTING — PROPOSED—
REOUIRED DEDICATION— FT —
METERSIZE I LINE Sl� 0. �OF FIXTURES VEPRV EQUIRED
SO NO 0
F MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY
DATE
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INSPECTION
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— __
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N NT.-PU
e EON A PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
L
G P, IN."LL
P I "'L
E RBS S'DEW oRI ST. , WILL RED URE
3 ODMAIN (CURBS. SIDEWALKS, VEWAYS MARQUEES. ETC.) WILL REQUIRE
7-
- SEPARATE PER�Isslolhl. .
CH
u CHARGE
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1
PERMIT APPLICATION! l8DDAYS
R STARTED W
PE T L T YEA WORK is
ENG. REVIEW FEES
IT_FID4�MoRIE INFoR
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESons
OF
ENG. INSPECTION FEE
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N INTEREST. AGREES TO INDEMNIFY. DEF NO AND HOLD HARMLESS THE CITY OF
I w
'EDMONDS.
LANDSCAPING
2 WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
I N S P ECT1111
ALLCt_AIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
T
F IT M THE ISSUANCE OF THI PERMIT. ISSUANCE 05 THIS PERMIT SHALL NOT BE
PLAN CHECK D
YC E
DEooEEMEDT MODIFY, WAIVE OR REDUCE ANY RE.11REMENT OF ANY C Ty ORDINANC:
a
N NY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PRDVISICN.**
I Y W Y THE,
NORUMITINA
TOTAL AMOUNT D�JE
IR CEIT/ 5-
I HERE Y ACKNOWLEDGE THAT: HAVE READTHIS APPLICATION THAT THE IrF6RMATION
APPLICATION
APPROVAL
CO RECT. AND THAT AM THE OWNER. OR THE DUI-Y AUTHOR
GIVENS IZED AGENT OF
T " ppill't— 1. - I P111.1 nIlI
NER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUt-ATING CONST RUC
THE OWS
EMPLOYED
C ALL
dllhg Offi—I 11 hl.lhl, Doplly P �d.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF THE LABOR
WORKMEN$ COMPENSATIOV �SUFPCE AND RCW 18.27,
"
CATE��7��/
(425)
�'E
1, /74
SIGNATURE (OWNER:
f I I"ve."
RELEASEDby DATE7
ATTENTION
EXTt333
IT 15 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1 09
FAX
PINK - OWNER - GOLD - ASSESSOR
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