20050650.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
04��p NAME/NA4E OF BL#lNf SS
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NAME
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NUMBER
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ADDRESS q,301,)
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PLAY NAMEISU B DIVISION NO.
LOT NO
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
13
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RW Permit Requited
13
EXISTING
PROPOSED
Street Use Permit Required
InSPOLlion Required
13
Sidewalk Required
13
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REQUIRED DEDICATION
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U�Ifing re2uirod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO13
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PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER PROPOSED ALLOVVED PROPOSED
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ALLOWED PROPOSED FRONT SIDE RE R
El NEW _�,__ENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
t�MBING MECH FRONT UR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
MIXED USE CHANGE OF USE I 1 2
PARKING LOTA ING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D PROVIDED 0.
GRADING FENCE
E] REPAIR CYDS El I — X —FT.) REMARKS
1:1 DEMOLISH E] TANK OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN;
T1PeT3F_DONST UCTIn E OCCUPANT
GROUP
NUMBER OF r c/ "IS I
OF DWELLING SPECIAL INSPECTION CONSULWNT--' OCCUPANT
—TUNITS LOAD
uj NUMBER
0 STORIES REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
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Efjg::�4 I A0__( C2 11'\ Description FEE Description FEE
V 0 7) 'Plan Check State Surcharge
HEAT SOURCE LOT SLOPE%-----FVESTED DATE Building Permit City Surcharge d
PLAN CHECK NO: Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
'BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION OWTHE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE FERMISSION.
N — Engr. Review
X PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
ILL!
IL PERMIT LIMIT* SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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-A IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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 Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording ee LReceint it R!Ee q 1,�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION P
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUT14ORIZED AGENT OF APPLI TION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is nota pornut until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building ollical or his/her Deputy: and Foes ire paid.and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recy�acl%nftledgecl in space provided
WORKMEN'S�I)MF,E
,!jSATI��URANCE AND RCW 18:27.
7 eom`GLALSJIGN�URE�� ATE
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SIGNATUR NER 0 G DATE GNE (425) 1 1
-LE ED Y D
ArftWt I o illif EXT. 1333
IT IS UNLAWFUL TO US //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
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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GARY HAAKENSON
CITY -OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: www.dedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
8/2/2005
Washington Energy Services'
01
2800 Thorndyke Ave W
Seattle, Wa. 98199
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RE: Gas Water Heater Change. Out
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Frank Davis
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.19306 89 P I W.
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Dear Candice,
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-usio'n about the permit
When the permit was. iss ed for this address there was some conf
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nurnber assigned. I wanted to send a copy to you w ith the correct permit #2005-0650 for
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your recor ds. Please adjust the site pink copy to reflect this correction.
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Sorry for the misunderstandin 9
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Sincerel
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JoAnne
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Permit peci list
Development Services Department
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(425) 771-0220 x1336
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Enc: WA M-t7� 111
1_\Tem1)\Ds,r,s\m as ter LatersTis Respond
Incorporated August 11, 1890
Sister Citv - Helkinan, Japan