20040084.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
MAILING ADDRESS
2�'A 2- 01 10 5-l", P I Vq
CITY ZIP TELEPHONE
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NAME
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CITY ZIP ITELEPHONE
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIR�TION,IDATE I CjIfXKI!T
TAX ACCOUNT PA C NQ
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NEW
RESIDENTIAL
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ADDITION
COMMERCIAL
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REMODEL
MULTIFAMILY
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REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR AqTIVtTY);, EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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oFIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
USE
ZONE
JOB
ADDRESS
PLAT NAMFISUBDIVISION NO
PERMIT EXPIRES
PERMIT C�,
NUMBER ""')
SUITE/APT#
7 T NO, LID NO.
1 LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO, OF FIXTURES
REM,
OWN
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required on all hot ilivater tanks
City Code. ECDC 19.30.020 (c)
TIESCIP Approved
RW Permit Required
street use Permit Roq'd
Inspection Requited
Sidewalk Required
Underground
Wiring required
PRV REQUIRED
YES 11 NO 11
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FIRE REVIEWED BY .5v E lu
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VARIANCE CTR CgjjAtj§HV&L&bWAb� �M§:TION BOND
*IE'WA:M�F, ; D POSTED
OYES ONO is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP I —
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LMf3U*NRl X441W Mimi DATE 5
REQ'D I PROVID5�TATER StRVICE SHMFF IL
REMARKS
CHECKED BY ITYP lok COPE OCCUPANT
GROUP &
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
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Plumbing
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PLAN CHECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIII PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180DAYS
IL
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTI-Y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
ANY OF ANY CITY ORDINANCE
LandscapeInsp.
Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE REQUIREMENT
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
c 1pt #
LReceipt #
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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COM PEN SATIPNJUkU RANCE AND RCW 18 27.
OF F ICIALS SIGNATURE DATE
SIGNATURE (OWNER OR AGENT) DATE SIGNED
(425)
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771-0220
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RELEASED BY DATE
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04,102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Gene Johnson
Plumbing, Inc.
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February 3, 2004
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Reference: Request for Withdraw & Refund
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Building Official
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Edmonds, WA 98020
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Dear Building Official: > z
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4-0084, with thejob address being 24201
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I am writing in regards to permit number 200 n
-mit was obtained oil January 29, 2004, and was originally going to
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be used for a plumbing i d an installation of a new waterline. However, the M M
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homeowner has since changed her mind about the work to be perronlied, U5
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be replacing the waterline. We would like to request that this part of the pen it be C cl).
withdrawn, and the maxilnUin amount available be returned. Please contact ine if you a)
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have any questions or concerns regarding this matter. Z
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Thank You,
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Laura St.Onge z
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Dispatcher
Gene Jolinsoii Plumbing & Heating, Inc I A/ir*Wig 6�oyo M
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Seattle: 206.789.7352 North: 425.775.9480
Fax: 206.789.7354 - www.genejohnsonplumbing.com
Seattle, Washington 98133
10011 Greenwood Avenue North
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MEMORANDUM
2/5/04
Date:
To: Debbie Karber, Accounting Assistant
arie Harrison
From: M
Subject: REFUND
a refund check in the amount of $64.00. Please mail the check to Gene
Debbie, please prepare
Johnson Plumbing Inc. at 100 11 Greenwood Avenue N, Seattle, WA 98133. The applicant has
withdrawn portions of the application. I have enclosed a copy of our receipt #23521 for your
records, Thank you.
Sincerely,
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'a ^arie A/o
Development Services Division Diiector's Signature
City of Edmonds cze Community Services
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ........................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
F�LIIJMBING:'
undergi�ound ............
4 Roug . ......
I ..............
inal ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The initials DAW are David
Wilson, a ternporary contract
inspector for the City.
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