20040790.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSI Ess
7
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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I CITY ZIP TELEPHONE
NAME
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CEL #
ADDRESS
P.Q. r,�01)X 102-1
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE D Py
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PROPERTY TAX ACCOUNT PARCEL NO V
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYOS
El
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, Bust OR-ACTIV 4XPLAIN:
w NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
0— -
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X� FT)
E]
OTHER
FIRE SPRINKLER
FIRE ALARM
-1 CRITICAL
AREAS
NUMBER
LOT SLOPE %
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.
PERMIT APPLICATION: 180 DAYS
uj
C. 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTIY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOI HE
0
j DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
X1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAI I AM THE OWNER, OR TIIE DULY AUIIIORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTIfORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SffllOkl RSU RANCE AND RCW 18.27.
SIG NATUjt0:r (OWNER ORN�gNjjj. I DATE SIGNED
[PERMIT EXPIRE 4 1
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4
USE PERMIT 2 U
ZONE NUMBER
JOB SUITE/APT#
ADDRESS -
PLAT NAM EIS UBDIVI SION NO. LOT No. LID NO.
LID FEE S
I ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Street Use Permit Roq'd
0
EXISTING — PROPOSED
inspection Required
CI
Sidewalk Required
E3
REQUIRED DEDICATION- IFT
Underground
Wiring required
E3
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 13 NO C3
REMARKS
OWNER/C
LE FOR EROSION CONTROLIDRAINAGE
In addition t.
the re"lla -C,&—
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Pressure/relief vaiyp�%_an app
listed expansion tank sha"
:=NGINEERI C 6011 01, all hot water tan
UPC 603
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADIII I INSPECTION I BOND
REO'D POSTED
OYES [INC) s
SIGN AREA I HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR I FRONT- UR SIDE REAR
J V'P®RKIN� _.- OT 1EA WED BY DATE
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'PE 0E ONSKTION OCCUPANT
eL I GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REOUIRED [] YES LOAD
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1PROGRESS INSPECTIONS PER UBC 1081IBC109/lRC109 FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
&0
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
rj
Recording Fee
Receipt #
CALL
FOR INSPECTION
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFF)CIAJfS_)IIGNATURE
13ATEj
(425)
'771 n030n
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TWE WT 10 N E)ff 1333
ITIS UNLAWFULTO USE OROCCUPYABUILDINGOR STRUCTURE UNTILA FINAL Lj
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/[RC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
-""ER TO CORRECT VIOLATION
Location of Violation (Address and Tax Account Parcel No): 221 10"' Place North Edmonds, WA
98020 Tax Account Parcel No. 00434206601100
Issued To: James & Karin Petrina, Property Owners
Address of Person This Order Is Issued To: 221 10"' Place North, Edmonds, WA 98020
Code Section Violated:. 2003 edition of the Uniforrn Plumbing ode Sections 504, 508.2, 508-5.,
508.23, and IRCM 2003
Description of Violation:— On behalf.of the property ow ner,_ Day & Night Plumbin obtained a
plumbing pen -nit (#2004-0790)..to install a hot water tank in Petrina's garage with no ngjy_��
The City Building Inspector perfon-ned an inspection on March 30, 2005 and noted three corrections
(copy of Correction Notice attached). The property owner has failed to make the corrections and recall
for the required final inspection. Also, the olurnbing pen -nit has expired.
Corrective Action Required: 1) Obtain a new plumbing pe it (application enclosed, fee $65) by
submitting a complete application with fees to the City and, 2) Once the approved pen-nit.is returned to
you contact the City Building Inspector for the required inspection by calling 425-771-0220 extension
Correction is Required no later than: 5:00pm (time) May 6, 2005 — (date)
If correction 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
$100.00 per day, or portion of a day, during which the violation continues.
Date Posted: L)ate maiICCI: Aprii zL, zuuD UUM OUI N'rZU
Issuing Party Jeannine L. Graf - Title Building Official
Signature
Cc: Day& Night Plumbing, POB 102 1, Lypilwood, WA 98046
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Pier/Porch .................
Retaining Wall ...........
Slab 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 NAI LING ...
SPECIAL INSPECTION ...
LO
15�
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. 1A
2 00 yowco) 7 94)
The Initials MT are Milton
Thompson, a temporary co.ntract
inspector rol- tile City.
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