20040305.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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&aAILING ADDRESS
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CITY
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NAME
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CITY
NAME
ADDRESS
Gii, CA, `0'�
ZIP
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ZIP
TELEPHONE
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TELEPHONE
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB TE/APT#
ADDHESSIgi/c.1 S)
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
HW Permit Required 13
EXISTING — PROPOSED
street Use Pormit Rect'd [3
inspection Required Q
Sirlowalk Required E3
REQUIRED DEDICATION— FT
underground
Wiring required [3
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
OBSERVED BY CITY INSPECTOR
CBL AFFIDAVITS SHALL NOT
"q D I ENGINEERING REVI ERFACCEPTED DATE'
CITY
ZIP
TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPEbTPY TAX ACZO�
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1:1 NEW
fErRESIDENTIAL
F� ADDITION
E] COMMERCIAL
-eREMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
01
F_ (TYPE OF USE, BUSINESS OR ACTIVITY) EXPD�IN
NUMBER NUMBER OF
OF t I DWELLING
STORIES NITS
DESCRIBE WORK TO BE DONE
IV
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
E]
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
E:iFENCE
( X _ FT)
OTHER
F
FIRE SPRINKLER
FIRE ALARM
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES ONO I $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (Fr.) R OSED SETBACKS (FT)
PROPOSED P Opb
ALLOWED FRONT SIDE REAR FRO T LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED 13Y DATE 5
REO'D I PROVIDED I IL
REMARKS
CHECKED BY
TYP= N
CjqE
OCCUPANT q
GROUP
CRITICAL
SPECIAL INSPECTION' [ARIEA
OCCUPANT
AREAS
NUMBER
REQUIRED [:] YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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LOT SLOPE %
VESTED 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.
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W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
tn, 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HFIRS, ASSIGNS AND SUCCIFSORS
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS 'THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALI. CLAIMS FOR DAMAGES OFWHAIEVEIA NATURE, ARISING DIRECTLYOR INDIRECHY
FROM THE ISSUANCE OF THIS PERMIE ISSUANCE OF THIS PERM11 SHALT. NOT BE
_j DEEMED 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR I IMIT IN ANY WAY I HE CIFYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION -
LI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I IT
'N IS CORRECT, AND TIIAT I AM THE OWNER. OR T-HE DULY AUTHORIZED AGENT OF
)WNER I AGREE TO COMPLY WITH CITY AND SlAlE LAWS REGULATING CONSTRUC-
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
W WC
ORKMEN'S COMPENSATION INSURANCE AND HCW 18,27
S
SIGNATURE (OWNER<VITAGENT) DAIE SIGNED
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a pert -nit until signed by the
Building Olficial or his/her Deputy. and Fees are paid, and
receipt is acknowledged in space provide
-I C TE
f SIGNATUR 7
FLFASFD BY DATE
ATTENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r
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
09/,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
ORDER TO CORRECT VIOLATION
Location of violation (Address and Tax Account Parcel No): 9101 244"' St SW, Ednionds WA
98026 T�.. Account Pa"XI 1'40- 000463302900304
Issued To:
Address of Person This Order Is issued To: 9101244"' St S_W., E nion�&WA�980�26��
�d
Code Section Violated:. Uniform Mechanical Code Sections 112 & 115 & 116 & 117.
Description of Violation: Fa t and final "urnace and hot
_Eailure to_contact Quity-for required gas piping
water tank inqgE���� echanicql2ennit #2004-_0305.------
Corrective Action Required: ired inspection by �Novet�nber 1�9200�4.Ga�si in�
test must be under pressure :)n the day_���
Correction is Required no later than: 3:30pm (time)- November 19, 2004 (date)
If col-l-ection is not made by the date and time specified in the Order, a Notice of
civil Violation shall be issued. The Notice of Civil Violation shall assess fines of
$100. 10 1) ijav, or pol-tion of a day, during NNI'llich tile violation continues.
Date Posted: Date Mailed: November 9_, 2004 Date Served
Issuing Party Jeannine L. Graf Title
Signature z
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SET13ACKS .....................
FOUNDATION:
Footing
wall ......
Pier/Pbrch
Reai ngva..-?'
Stab Insulation ..........
PLUMBING:
Underground.............
Rough -In ...................
Commercial Final ......
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 D�, L I — I./, — 0 1�
OCCUPANCY .................. __1 I v
2004awo,3cS
Tile initials MT are Milton
Thompson, a temporary contract
inspector for tile City.
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APPLIED IMAGE
16S3 E.MPIN STREET
ROCHESTER, NY 14609
TEL (716) 482-0300
FPX (716) 288-5989
Precision I PA4 G E Products & Services
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CERTIFICATE OF
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PRINTED NAME:
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Micro Com, Systems Ltd.
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