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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT
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ADDRESS 2,070/
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REMARKS
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LOT NO. LID NO,
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RW Permit Required 13
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STATE LICENSE NUMBER E4XP7[ON DA�E y VARIANCE ("' MITI!c1m" SEPA
ITS_SHMVVAT LETED EXEMPT
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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ADDITION COMMERCIAL. COMPLIAN 0 nnectors required 9
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PAR aam4wng DATE 5
REMODEL MULTIFAMILY SIGN EQ'D IMC 803.2 0.
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GRADING FENCE ti rou 11 unhelte'll sPaces-
REPAIR CYDS ( x FT.) REMARKS
DEMOLISH TANK OTHER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAI
TYPE O�.W S UCTI� CODE OCCUPANT
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-'J 0 '�-h HI'm tzbil Rue, GEOTECH REPORT
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10101ol "Amm-cc Qo' ax, &A j Description FEE Description FEE
40 1 of �'lz U-ft ity 16t;L-1 ti
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HEAT SOURCE LOTSLOPE% VESTED DATE
oil <'- Building Permit City Surcharge
P, AN CHEC K NO: Plumbing I Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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0- PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
oAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt #
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
I HEREBY ACKN6WLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy and Foes are paid, and
IN VIOLATION OF THE LABQ1L_CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPE>SA;eMATANCE AND RCW 18:27. F IALS SIGNAT ATE
SIGN RE OWNE 0 E T): DATE S71GD (42!;) ..L'
771-0220 _RELEA BY)
KTTFfNTION 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 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMORANDUM
Date: December 7, 2005
To: Nicole Daniels, Accounting Assistant
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From: JoAnne Zulauf
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Subject: REFUND
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check in the amount of $105.00 to Washin nergy Services.
Nicole, please prepare a refund gton E
Washington Energy Services made a duplicate payment of $105.00 for a permit for, the
installation . of a furnace, free standing stove and gas piping for the McCallum residence, 22701
98"' Ave W, permits 2005 -0394 and 2005-0471 (to be voided). Please mail the check to WESC.
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at 2800 Thorndyke Ave W, Seattle WA 98199. Please deduct $95.00 out of the building fund
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and $15, from the city surcharge fund. Please note that WESC paid for several pen its on
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receipt. I have enclosed a copy of our receipts #26349 and #26515. Thank you!
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Sincerely,
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JoAnne Zulauf
Development Services Division Director's Signature
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City of Edmonds cza Community Servi ces
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