20030013.pdf0 ,
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ann Harrington
MAILING ADDRESS
24019 104th Pl W
CITY ZIP TELEPHONE
Edmonds 98020 1206-546-0275
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
Day & Nite, Plumbing & Heatin
ADDRESS
5700 B 188th St SW
CITY ZIP TELEPHONE
Lynnwood 98037 1425-775-
STATE LICENSE NUMBER EXPIR ION D E
DAYNIPHO44CM I I tj N;�'
PROPUE994 C 16NIPARCELNO.
96 00200
NEW
RESIDENTIAL
AUDITION
0
COMMERCIAL
0
REMODEL
0
APARTMENT
K]
REPAIR
0
GRADING CYDS
0
DEMOLISH
0
TANK
oGARAGE
0
RETAINING WALL
CARPORT
onr1wrov
(TYPE OF USE. BUSINESS OR ACTWjX&*LAIN:
M PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
0 OTHER
M RENEWAL
NUMBER NUMBEROF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
Repipe hot & cold water
lines for house to Ref. Kitchen sink
,Dishwasher. Plus run new gaspipe to
Kitchen ranqe and fir.00lace
NEtt6OURCE GLAZING % LOT SLOPE 0%
PLAN CHECK NO: IVESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD 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 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 PROVISION.*
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DATE SIGNED
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USE
ZONE
JOB
ADDRESS
24019 104t
PERMIT EXPIRES
PERMIT
NUMBER
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SUITE/APT#
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use loarMll Req'd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES E3 No E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJDRAINAGE
LIj 11
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP P-A Q
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ALLOWED nOF413
PARKING w 00
REO'D I PROVIDED
It
DATE
SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
0 YES 0 NO
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
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III PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
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ATTIENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
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,rp�SURCLARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
RECEIPT 11)4e
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
771-0220
EXT 333
771-0221
FAX
FEE
APPLICATION APPROVAL
'tpi cation is not a permit until signed by the
lcl or his/her Deputy: and Foos are paid. and
apfiDlisacknowloduAdinspacoprovidod. ,
EWSED BY DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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PATE RECEIVED
.CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
9WNER NAME/NAME OF BUSINESS
Ann Harrington
MAILING ADDRESS
24019 104th Pl W
CITY ZIP TELEPHONE
Edmonds 98020 1405-546-0275
NAME
ADDRESS
CITY ZIP I TELEPHONE
Day & Nite, Plumbing & Heating, INC--,
ADDRESS
5700
8 188th St SW
CITY ZIP
TELEPHONE
Lynnwood 98037
425-775-6464
STATE LICENSE NUMBER XPIRATION DATE
C
DAYNIPHO44CM
1 1 7 _10
PROPUUdfg4QCD URCE f
quysi 02,uu
E]'� NEW RESIDENTIAL PLUM13ING MECH
COMPLIANCE OR
ADDITION 0 COMMERCIAL CHANGE OF USE
REMODEL APARTMENT SIGN
t3 REPAIR GRADING CYDS ID FENCE X FT)
0 DEMOLISH 0 TANK OTHER
C3 GARAGE E] R=RING WALL RENEWAL
z CARPORT R Y_
(TYPE OF USE. BUSINESi OR AC31P�V:
,u NUMBER
OF
NUMBEROF
DWELLING
CRITICAL
AREAS
0' STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Repipe hot & cold water
lines for house to Ref. Kitchen sink
IlDishwasher. Plus run new gaspipe to
Kitchen ranqe and fireDlace
U __]%a! I PERMIT EXPIRES ±±ZU
USE PERMIT
ZONE NUMBER
J013 SUITE/APT#
ADDRESS
24019 104th Pl W
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street Use permit Req d
EXISTING - PROPOSED
Inspection Required C1
Sidewalk Required
REQUIRED DEDICATION- FT
ergr ,
Witing tequ d 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
YES 13 NO C3 9
W
REMARKS
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1NrnPrnhITAfirjQ8,aL�PONSIBLE FOR EROSION CONTROUDRAINAGE a
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FIRE REVIEWED,BY/.,,�� DATE Lu
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
REO'D POSTED
E3 YES C3 NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED POSED ALLOWED , PROPOSED.
EXP PRO
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING :n11%JL(jr jWfifjjffDdY DATE
REO'D I PIVMQM --ft C
bHECKED BY TYP NSTR OCCUPA
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SPECIAL INSPECTOTRASEA OCCUPANT
REQUIRED C] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER 1IBC 108/FINAL INSPECTION
VALUATION
PLAN CHECK FEE
IOU OURCE ' I GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
FEE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMI�ION.
t It I WI
r. �
PERMIT APPLICATION:\! iiQ DAVO
*WmrSURCHARGE
PERMIT LIMIT-. I YEAR - PROVIDED W06K 1d`STARTtD WITHIN 180 DAYS
lENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
9 DEEMEDTOMODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
0 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
RE-CEIPT
M1
TOTAL AMOUNT DU'E
I
L, -
I
I
I HEREBY 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. VAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
pplication is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
B d
icial or his/her Deputy: and Fees are paid. and
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
("B,
cpipt Is acknowlod
T I g# in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
--- -_
OF
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SIGNATU ROR
DATE SIGNED
(425)
WCS�ITURE�
043
L�pz/e"-3
771-0220
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-wE-WEDBY
DATE
ATT ION
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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