20030287.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME�FBUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. L�D NO.
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requIred on all hot water tanks
DATE
FIRE REVIEWED BY DATE
SH9RELINE OR ADB#
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION COMMERCIAL
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40escripti n
FEE
Description
FEE
In C�aArlk
Plan Check
State Surcharge
IRCE
5LIONG %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT OkUTHORLEES ONLY THE WORK NOTED. THIS PERMrT COVERS WORK TO
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BE DONE ;N PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
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D OMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
11
Engr. Review
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PERMITAPPILICATION: 160DAYS
06
PERMIT UMM. I YEAR - PROVIDED WORK IS STARITED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
Landscape Insp.
Total Amt. Due
z 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Recording Fee
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ Tills APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building 01111clal or his/her Deputy: and Foos are paid, and
CC
IN VIOLATION OF THE�L^ACODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEITSYQ�PEN IN RANCE AND RCW 18.27.
(0 R GENT) DATE SIGNED
11425)
OFFICIALS SIGNfURE D TE
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771-0220
01
RELEASED BY DATE
ATTENTION
EXT 1333
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
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
GREEN - ACCOUNTING
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CITY OF EDMONDS
121 STH AVENUE NORTH - EDMONDS, WA 9W20 * (425) 771-0220 * FAX (425) 771 -=I
Website: wwd.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building * Engineering
April 21, 2003
Washington Energy Services
2800 Thorndyke Ave W
Seattle, WA 98199
RE: Mechanical/Plumbing permit for 21718 97 th Ave W, Edmonds 98020
GARY HAAKEN
MAYOR
During our monthly permit audit it came to our attention that two permits were issued at
the above address for the same work. Pen -nit numbers 2003-0248 and 2003-0287 for the
Olson household are identical. One permit was issued on 4/8/03 and the second on
4/18/03.
Please provide written verification that you would like a refund for one of these permits
and indicate which permit you wish to be refunded for. Neither permit has had any
inspections performed. Once you choose a permit. number to be refunded that permit will
be "void" and no inspections can be called in under that permit number.
If you have any questions please don't hesitate to contact me at 425-771-0220.
Sincerely,
Theresa Urnbaugh
Permit Coordinator
Incorporated August 11, 1890
Sistpr ritu - Hp.kinan Janan
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