20040029.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF 13USINESS
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MAILING ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS
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PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
nW Permit Roquired 13
Street Use Permit Roq'd E3
EXISTING PROPOSED
Inspection floquired [3
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CITY ZIP
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL
Rf PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING
E] REPAIR CYDS
FENCE
( X FT)
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
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(TYPE OF USE, BUSIN
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NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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 REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT LY OR INDIRECTLY
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X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMI1 SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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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 ITI.27.
s,��UIIE (OWNER OR A ENT)/ DATE SIGNED/
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VARIALL Mr(!U— HORELINE OR ADB# INSPECTION BOND
REO'D POSTED
EIYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED ROPOSED
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
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TO BY [41TY INSPECTOR to
IDAVITS SHALL NU I
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AE ACCEP I ED
FEE
Description
State Surcharge
City Surcharge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acl,nowledged in space provided
OFFICIAI S SIGNAjWHF D TF
(425)
ILI, 1zf11E1_)
771-0220 BY' DAT�
ATTENTION t:A I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0111GINAL FILE YELLOvV - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04!02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUN1 ING
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwacLedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
GARY HAAKENSON
MAYOR
December 22, 2003
Northwest Mechanical
Attn: Anissa Shoemaker
3204 NE 145t' St
Shoreline, WA 98155
RE: Application for HWT with gas piping for Cannon/24228 Firdale Ave
Dear Anissa Shoemaker:
The City is in redeipt of the above referenced permit application. In order for us to issue
the permit we require an additional $40.00 and Northwest Mechanical needs to renew
their City of Edmonds Business License.
We show the application being for a gas to gas hot water tank with one new gas piping
outlet. We do need to know what the additional or new gas piping outlet is for as well.
Please make the check payable to the City of Edmonds and forward any additional items
and/or information to my attention to be matched with the permit application. If you
have any questions please don't hesitate to contact me.
Sincerely-,
'1y
Ag
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Permit Coordinator ab
Incorporated August 11, 1890
Sister Citv - Hekinan. Jat)an
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation .......... ITI
PLUMBING:
Underground .............
0 M
C=
Rough -In ................... M 0
Commercial Final ...... 0 0
C
HEATING: 3: M
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Gas Test .................... C
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Gas Piping .................
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Equipment ................. 0 -n
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Commercial Final ....... __4
EXTERIOR SHEATHING rn M
NAILING .......................... 0
0 171
FRAMING ........................ C cf)
FIRST FLOOR FRAMING... rn 0
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
CD
SHEETROCK NAILING z
0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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