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_ CONSTRUCTION PER
MIT APPLICATION
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OWNER • `t • •
NAMEMAME BUSINESS
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ADDRESSMAILING
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#13 • : • Olympici3PUBLIC RIGHT OF OFFICIAL
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•EXISTING . REQUIRED DEDICATION.
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Edmonds 98020 771-9249
PROPOSED
RIGHT OF . •N PERMIT REQUIRED ■
STREET USE PERMIT REQUIRED 0
ADDRESS
TELEPHONE NUMBER
NAME
Kozy Heating
cc ADDRESS
0 8223 Sunn side Ave N
F CITY ZIP TELEPHONE NUMBER
o Seattle 98103 527-5004
U STATE LICENSE NUMBER
KOZYH**1 1 0NA
Legal Description of Property - include all easements
(show below or attach two copies)
Tax Account Parcel No.
L-1 NEW RESIDENTIAL
ADD/ALTER COMMERCIAL
REPAIR APT. BLDG.
❑❑ EXCAVATE, FILL
DEMOLISH OR GRADE
CARPORT
REMODEL GARAGE
❑ WOOD STOVE/ ❑ RETAINING WALL/
INSERT ROCKERY
TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
V.'�J PLUMBING
n
L MECHANICAL
ElSIGN
FENCE
( x FT)
77 SWIM
RENEWAL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Install 100m btu cfas conversion
r and 40
Plan Check No.
This Permit covers work to 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
Permit Limit: 1 Year. Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
v) successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
ir
a 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
° nor limit in any way the City's ability to enforce any ordinance
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
ER OR AGENT) (DATE SIGN
METER SIZE (BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE OR CU
SETBACKS —FEET
FRONT SIDE
PLANNING REVIEW BY
SHORELINE#
DATE
HEIGHT I LOT COVERAGE
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
G/
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
❑ YES C' NO �3
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
STATE SURCHARGE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
t ; A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
102•87
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
CALL FOR
INSPECTION
771=3202
FEE
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IDS,1)6173
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
BY: DATE
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ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assesso/
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RECORD OF INSPECTIONS
` INSPECTOR DATE APPROVED
SETBACKS .. .......... .
FOUNDATION:
Footing ..:...........:.
y, Wall .....:.............
-.
tI: Pier/Porch . ........
Retaining Wall.......... '
PLUMBING:
,
Underground
Rough -In
i CF ......
HEATING: _
Gas Test.
Gas Piping
Equipment . .
1
CF ............
_ '.. FRAMING
SHEETROCK NAILING .. .
SPECIAL INSPECTION
•
FINAL APPROVAL 9
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'-'FOR OCCUPANCY
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