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USE PERMIT
CITY OF EDMONDS ZONE NUMBER !8
CONSTRUCTION PERMIT APPLICATION joB
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(� t / / 1 4 LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
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Z MAILING ADDRESS
CIT 4 TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
J J EXISTING _ _REQUIRED DEDICATION
NAME PROPOSED..- p
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED i W
w ADDRESS STREET USE PERMIT REQUIRED Z
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U SEE ENGINEERING MEMO DATED w
a CITY TELEPHONE NUMBER
REMARKS
NAME
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cc A {rSS
O , 3 ' METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
CITyN TELEPHONE NU�aER cc
p REMARKS 3 I
U STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO. {
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies)
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VARIANCE OR CU PLANNING REVIEW BY DATE
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NEW � RESIDENTIAL � PLUMBING
ADDIALTER El COMMERCIAL El MECHANICAL
�1 REPAIR El RETAINING WALL El SIGN
EXCAVATE FENCE CHECKED BY TYPE OFC NSTPUCTION CODE HEIGHT
DEMOLISH OR FILL X FT) to 198'_
PRE-MOVE
OMPLIAN EIN SWIM SPECIAL INSPECTOR AREA OCCUPANCY yr
REMODEL COMPLIANCE INSP. POOL REQUIRED GROUP R-3 LOAD
PANT
❑ WO ❑ APT. BLDG RENEWAL REMARKS
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INSERT
g PROGRESS INSPECTIONS PER UBC 305 0
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UMBER OF (LCl I ►tt,CE GI-�I t WE L( aEl2. US D � m
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) I S XLLCO C is S RS OF EJETIZIr
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PLAN CHECK FEE
INSTIL-LL LO? 1 '►RE:?u�C �
BUILDING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL ICJ
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
N successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and 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 PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
° nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE /&SOD 82%'
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
OFFICIAL'S SIGNATURE DATE
"3 fs� CITY OF
�S'" c�~ EDMONDS2��
y 3-(e-88
AT E N T i O N 771.3202 RELEASED BY: DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE i
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC /
CHAPTER 3. PINK — Owner GOLD — Assessor
102.87
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�! CITY OF E D M O D S LARRY s. NAUGHTEN
r MAYOR
„tot 250 5lh AVE. N. • EDMONDS, WASHINGTON 98020 • (206) 771.3202 SY 'r
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
of
January 19, 1988
Mr. Jack Ely
18226 Olympic View Drive Ar
Edmonds, Washington 98020
1,;
On January 11th, 1988 the City of Edmonds Fire department responded to
a call at your residence located at 18226 Olympic View Drive. A
subsequent incident report wadivis
s forwarded to the ad1been ginstalled;with
notification from you that
a new chimney stack h
Section 305 of the 1985 Uniform Building Code requires a building
permit for chimney installation, according to our files no permit was
obtained for this work.
Please contact the building division at 771-3202 ithin
the chim�eyayslfate youof
this letter to schedule for a site inspection of
have any questions feel free to contact me at the same number.
Thank you,
Jeannine L. Graf
Permit Coordinator
Y
PUBLIC WORKS •
PLANNING • PARKS AND RECREATION ENGINEERING
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CITY OF EDMONDS
250 51h AVE. N. EDMONDS. WASHINGTON 98020 • (206) 771.3202
COMMUNITY SERVICES
February 4, 1988
Mr. Jack Ely
18226 Olympic View Drive
Edmonds, Washington 98020
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
By letter dated January 19, 1988, you were informed that Section 305 of
the 1985 edition of the Uniform Mechanical Code, as adopted by the
City, requires a permit for installation of a solid fuel burning
appliance.
Any appliance vented into an existing chimney requires approval of the
chimney (UMC 901). It is my understanding that a new stainless steel
liner was installed in your chimney. Chimney liners including ALL
COMPONENTS of the liner, must be approved by a testing laboratory.
I contacted your installer, Chimney Masters of Everett, and requested
from Bob listing information on ALL COMPONENTS of your new liner. This
is necessary in order to determine if the adapter Chimney Masters
installed is APPROVED for a Lopi insert.
I received the listing information of the liner, but nothing on the
appliance to liner adapter.
As the owner, it is your responsibility to provide the necessary
information to obtain the required permit. Neither my staff nor I have
the time to do the legwork to obtain this information. Please contact
your installer and obtain the information requested abovethatis,
listing information for the adapter from the Reliance chimney liner
to the Lopi insert.
If there are any questions, please contact the building division within
five days date of this letter.
Thank you,
Harold Reeves
Building Official
PUBLIC WORKS a PLANNING
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CM ENVIRONMEMAL SERVICES, INC.
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SS124-1
The Reliance Rigid Liner, round & rectangular liner, and Accessories are
listed with CMNI Environmental Services, Inc.'s, Quality Control Program and
are subject to on -site factory verification documentation service visits to
ensure products uniformity. Should further information be required, please
contact our office. Be advised that no specific test data may be released
without prior written consent of the manufacturer. Thank you.
Authorized Signature:
t i.
Ra Downey
Safety Lab Director
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rib WASHINGTON STATE FIRE INCIDENT REPORT
FIRE
EPT,
NFIRS 1
1 ❑ delete
2 ❑ change
FDID
INCIDENT NO,
EXP,
MOr
DAY
YEAR
DAY OF WEEK 6 ❑ Thursday
ALARM TIME
ARRIVAL TIME
TIME IN SERVICE
10
3 (
/
( (
2;rMo day 4 ❑ Wednesday 7 ❑ Saturday
1�
3
(I (
( 3
U
It
-TYPE F SITUATION FOUN
B
1. FIRE, EXPL. 3. RESCUE I 5, SER, CALL 7. FALSE
2. PRESSURE RUPTURE 4, HAZ, COND, 6, GOOD INTENT 9, OTHER
Z
MUTUAL AID
O W
1 ❑ Extinguishment 5 ❑ Stand by a ❑ Fill in. Move up
1 ❑ Rec'd
0<
UQ
2.-L] 9eecue Only 7 ❑ Selvage 9 ❑ Not Undetermined
3 lnveatigelion only 7 ❑ Emerg. Med. 0 ❑Undetermined/Not reported
3
2 ❑ Given
QF"
❑
Z91v7A
4 Remove Hazard
FIXED PROPERTY USE (Occupancy)
IGNITION FACTOR
[
CORRECT ADDRESS (Up to maximum of 21 characters))/
ZIP CODE
CENSUS TRACT
)
et
OCCUPANT NAME (LAST, FIRST, Mri.)
TELEPHONE
ROOM or APT.
OWNER NAME I (LAST, FIRST, M.I.)
ADDRESS
TELEPHONE
12
METHOD OF ALARM""CO.
INSPECTION
SHIFT
NO, ALARMS
1elephone direct 4 ❑ Radio 8 ❑ Voice signal municipal alarm signal
DISTRICT
L13
2 U Municipal alarm system 5 ❑ Verbal 9 ❑ Not classified
3 ❑ Private alarm system 8 ❑ No alarm rec'd. 0 ❑ Undetermined or not reported
/
7 ❑ Tie -line (911)
NO. FIRE SERVICE PERSONNEL
NO. ENGINES
NO, AERIAL APPARATUS
NO. OTHER VEHICLES
RESPONDED
RESPONDED
RESPONDED
RESPONDED
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COMPLEX
MOBILE PROPERTY TYPE
(Complete Line S)
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02
AREA OF FI ORIGIN
EQUIPMENT
IN IGNITION
(Complete Line T)
' �7
'INVOLVED
-7
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FORM OF HEAT IGNITIO :
TYPE OF
MATERIAL IGNITED
FORM OF MATERIAL IGNITED
71
METHOD OF
EXTINGUISHMENT
2
❑ Make shift
aids
5 ❑ Pre -connect
hose/tank only
8 ❑ Master stream device
3
❑ Portable extinguisher
6 ❑ Pre -connect
hose/hydrant
draft standpipe
9 ❑ Not classified
/
I3 1 Self
extinguished
g
4
❑ Automatic
ext. system 7 ❑ Hand -laid hose/hydrant draft standpipe
0 ❑ Undetermined or not reported
I/
LEVEL OF FIRE ORIGIN
ESTIMATED
DOLLAR LOSS
1 Z&l -Grade
level to 9 ft.
8
❑Over 70 lest
2 ❑ 10 to
19
feet
7
❑ Objects In flight
3 ❑ 20 to
29
feet
8
❑ Below ground level
4 ❑ 30 to
49
feet
9
❑ Not classified above
%1
6 ❑ 50 to
70
feet
0
❑ Undetermined
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NUMBER OF
STORIES
CONSTRUCTION TYPE
1J�1-1-story.
4 ❑ 5 to 8 stories.
7
❑
25 to 49 stories.
1 ❑ Fire resistive
8 ❑ Unprotected ordinary
2 ❑ Heavy timber
7�5-Ptolecled wood frame
2
❑ 2 story.
5 ❑ 7 to 12 stories.
8
❑
50 stories or more.
3 ❑ Protected noncombustible 8 ❑ Unprotected wood frame
3
❑ 3 to 4 stories. 8 ❑ 13 to 24 stories.
0
❑Number
of Stories
undetermined or not reported.
4 El Unprotected noncombustible 9 ❑ Not classified above
7
5 ❑ Protected ordinary
0 ❑ Undetermined or not
reported
EXTENT OF
DAMAGE
DETECTOR PERFORMANCE
SPRINKLER PERFORMANCE
Flame
Smoke
1 ❑
Det, in room or space of fire origin-oper.
1
Confined to
the object of origin
1
❑
1 ❑
2 ❑
Del. not in rm. or space of fire origin-oper.
1 ❑ Equipment operated
2
Confined to
pert of room or area of origin
2
❑
2 ❑
3 [1
Det in rm. or apace of origin not oper.
2 ❑ Equipment should have operated —did
not
3
Confined to
room of origin
3
El
❑
❑
4 ❑
4 ❑
Del. not in rm. or apace of origin -not oper.
3 ❑ Equipment present, lire too small to oper.
4
5
Confined to
Confined to
the fire -rated comp. of origin
floor of origin
4
5
❑
5 ❑
5 ❑
Del. not in rm. or space of fire origin
8->9-,No equipment present (N/A)
e
Confined to
structure of origin
8
❑
e ❑
but fire too smell to oper.
9 ❑ Not classified
7
Extended beyond structure of origin
7
❑
7 ❑
8 C1
No detectors present
0 ❑ Undetermined or not reported
0
Undetermined/not
reported
0
tFr
IN 0 ❑
rJ'
9 El
classified
damage
type (N/A)
9 i�
`
Undetermined
9
No
of this
011
or not reported
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HEAPING sysTEF.1
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