20010538.pdfDATE RECEIVEJ FPERMIT EXPIRES
ZONE �ERMIT
CITY OF EDMONDS USE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTN
ADDRESS 1-9215 80th Pl. W.
OWNER NAME/NAME OF BUSINESS
Vada Matthew PLAT NAM E/SUBDI VISION NO. LOT NO. LID NO.
Im MAILING ADORES LID FEE S
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10� 19215 80th Pl. W. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required 0
Street use Permit Req d 0
ZIP TELEPHONE EXISTING - PROPOSED inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION- Fr Underground
9 i 425-776-3883 Wiring requited 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 0
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3: OWNE%LON TRACTOR RESPONSIBLf FOR EROSION CONTROUDRAINAGE
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< CITY ZIP TELEPHONE 7V %AL 19 16 6S �r_ v-i �a (A (C�_
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NAME S6-r-d
Day & Niter Plumbing & Heating, INC. _N ING AEVIEWED/DATE
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Lynnwood 98037 425-353-646
1 EXPITATION DATE VA INF I I I 13OND
STATE LICENSE NUMBER e U'laftr Wimup POSTED
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DAYNIPHO44CM E A I-
PA E IGNAREA HEI 3HT
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NEW RESIDENTIAL L( & 610W :;;;�TBACKS (FT)
PLU BIN EC ALLOWE P ED FRONT SIDE REAR FRONT LJRSIDE REAR
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ADDITION COMMERCIAL C] COI IANC 2
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PARK E OAT E n
REMODEL APARTMENT El Sl REO'D CL
GRADING C tv, i BE I ISATAL.LED ON THE
REPAIR CYDS FT) REM LINE AIR IT f 4 UILDING
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GARAGE RETAINING WALL E]
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P (TYPE OF USE. BUSINESS OR ACTI�JTY)
2: % BY jTYP?jCONSTR OCCUPANV:
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C3 _TDWELLING SAWL INSPET%R' AREA OCCUPANT
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DESCRIBE WORK TO BE DON'Re-RoutiNwal%arvi MARKS
OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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appox. 60ft, install new rujilKaw"41 1v ECDC 19.30.020
A PRESSUREREGLjLA370gVAI VEaRja to
,re -corner to existing copper in crawl SHALL BE INSTALLED NEAR
cap off 1/2" line into concreate, TIEB WATER SlFdTOFF
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install 40gal HWT under counter, I hosE
bib under K/S, install yard hydrant. VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE__] GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
S��'�TE -URCHARGE
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
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w IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION" RECfi,IFj
TOTAL AMOUNT DUE G
1 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 APPLICATION APPROVAL
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Thi� application is not a pormit until signed by Ine
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Buildi ficial or hisihor Deputy: and Fees are paid. and
IN VIIDLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Iroc )tpl isacknowle5pd in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFrc SIGNATURE
SIG DATE SIGNED (425) 4
/ //PIA'%�
771-0220 RfrED BY ATE
AUPtKTIOW EXT 333
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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To: Teresa Stone, Accounting Assistant
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From:
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Subject: REFUND
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Teresa, please prepare a refund check in the name of Day & Nite Plumbing & Heating, Inc. in the
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amount of $95.00. The permit #2001-0538 was issued July 24, 2001. The applicant has
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requested the permit be withdrawn. Per Uniform Building Code Section 107.6 Fee Refunds.
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Please mail the check to: Day & Nite Plumbing & Heating, Inc.
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5700 B 188"' St. SW
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Lynnwood, WA 98037
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I have enclosed a copy of our receipt #17968 for your records. Thank you.
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Sincerely,
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Development Services Division
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City of Edmonds cza Community Services