20020146.pdfDATE RECEIVE:,�
PERMIT EXPIRES
USE P E R MIETR
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS 521 12th Ave N
OWNER NAMEINAME OF BUSINESS
Gordan Granade
PI -AT NAMEISUBDIVISION NO. LID NO.
MAILING ADDRESS
LID FEE $
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
521 12th Ave N
CRY ZIP NE
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EXISTING - PROPOSED o
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Edmonds 98020 425--775-8596
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NAME
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES 0 NO 0
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROILADRAWAGE
CITY zip
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NAME
Fast Water Heater
ENGINEERING REVIEWEDIDATE
ADDRESS
12601 132 Ave NE
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DESCRIBE WORK TO BE DONE
Remove/replace gas water heater
REMARKS
PROGRESS INSPECTIONS PER LIED 108/FINAL INSP ECTION REO'
basement laundry room
40,000 btu's
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VALUATION
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THIS PERMIT ALITHO 2ES ONLY THE WORK NOTED. THIS P AMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADJNG'111L
. DOMAIN tCURBS, SIDEWALKS, DRIVE MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE WPEARYSM'ISSION.
PERMIT APPLICATION! 180 DAYS
PERMIT LIMIT,' I YEAR -PBQVIDIO WORK 11 STA"TE WITHIN IBODAYS
ENG REVEWIE's
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHAL HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG INSPEC, RON FEE
;APPLICANT.
N INTEREST AGREES TO NDEMNFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECT ION FEE
CE",
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDMANC
PLANCRECK DEPOSIT
0 NOR LIMIT IN ANY WAY THE CITYK ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
TOTAL AMOUNT DUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. t AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONRT
U`y`ED'
CALL
ION: AND IN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPL
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMENS COMPENS�� RANCE AND HOW 18 27.
OFFICIALS SIGNATURE DAIL
12LI DUE SIGNED
(425)
LSIGNATURE
771-0220 RELEASED BY DATE'
ATTENTION
EXT 1333 -------------------
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-FIL YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK -OWNER COLD, ASSESSOR
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