20050082.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF. BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
PERMIT EXPIRES Lt'
ERMIT
NUMBER L/'G��-
JOB �- _ SUITEIAPT#
ADDRESS /
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Required E3
Street Use Permit Required 13
EXISTING_ PROPOSED _ Inspection Required Q
Sidewalk Required O
REQUIRED DEDICATION FT Underground 0
Wiring required E3 -
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
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REMARKS d «""^^.^--
OWNERICONt"T L FO ROSION dt7f7Trtt7c7DR z
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ADDRESS
FIRE REVIEWED BY .DATE w
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STATE LICENSE NUMBER EXPIRq10N ATE CC ECK Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIR��� � i REQ'D COMPLETED EXEMPT
� YES � NO
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PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
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� WAIVER13 LALLOWED PROPOSED ALLOWED PROPOSED
jSTUDY .�.am,Y.,..�
LOT C APE REQ Peening OSED T.)
❑ NEW RESIDENTIAL V COMBING MECH ALLOWED; YROi 11 E . REAR t��� R R
❑ COMMERCIAL COMPLIANCE OR f�aB.Q?t! r A�PliAnCes Agq�n z
1:1 ADDITION MIXED USE ❑ CHANGE OF USE _
❑ PAR 00 AN EWED "Z g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ,,,��
❑ REPAIR ❑ GRADINGCYDS ❑ (ENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
_ ❑GARAGE ❑ RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE A ARM
a (TYPE OF USE, B SINESS OR ACTIVITY) EXPLAIN:
�1 OCCUPANT
Urx / TY N(jS GROUP .
ut NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
��% r REMARKS
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STRUCTURAL DESIGN
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�- Description FEE Description FEE
(/ Plan Check State Surcharge
HEAT O C SLOPE°/ V EO DATE
Building Permit City Surcharge �t
PLAN HECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT. COVERS WORK 70 Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
� Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
art
Q) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
wIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
KEDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection' Receipt #
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
n DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due r
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee Receipt #L-
1 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 Building Official or hislher Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LA ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION -
WORKMEN'S COMPENSAT NCE AND RCW 18:22 C OFFICIALS IGNA RE D/JE
SIGN RE (OWNER NT : DATE SIG ED (425)A /
`L �� 771 0220 LEA47BY
DATE
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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 CERTI- ORIGINAL - FILE YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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t J J','s,;,";,;: GARY HAAKENSON.
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CITY OF EDMONDS MAYORpl
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121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771.0220 • FAX,(425) 771.0221. a
Website: wwva dedmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
I 0 Planning • Building • Engineering
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August 19, 2005
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Asao Sakakibara ,'
L. 906 Sea Vista Place L owl
Edmonds, Washington 98020 L L L 65 #:.
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RE: Gas Water Heater Permit 92005-0582 L L m.o
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Dear Mr. Sakakibara: L. m
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According to City records Washington Energy Services obtained a permit on your behalf to replace a C z
gas hot water heater in your downstairs utility room (reference pernlit #2005-0082 copy enclosed for ;
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your convenience). The Uniform Plumbing Code regulates the installation of gas piping and hot water m
tanks and re uires a final installation ins ection in order to close out the ermit and to be assured no ''
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life -safety issues exist,
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Unfortunately, as of this date there is no record of inspection request. My staff placed several phone p N t,
L. calls to Washington Energy Services and confirmed that the work is finished. We understand that it is C j=
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sometimes difficult to arrange a day and time for inspection, especially when family members are
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working; however the code requires the gas piping and final inspection. r
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Please contact the Building Services Inspection hotline at 425-771-0220 extension 1333 by August 31, .�
2005 to schedule a day and time for inspection. Our inspection hours can be from 7:15am to 3:45pm,
Monday through Friday. If these times are not convenient for you perhaps another family member or 1
neighbor or building manager could allow the City Building Inspector access for inspection. We will L COL_
tryto accommodate your schedule as much as possible. If there are circumstances beyond your control z
that will prevent you from complying by August 31, 2005 please call me directly at 425-771-0220 0
extension 1226. Lrn
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. Sincerely, L
Jeannine L. Graf L; t
Building Official L L L I It
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Incorporated August 11, 1890 i .
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Sister,City Hekinan, apan
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