20030124.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
5013 152nd St NE - �ELEPHONE
CITY ZIP
Marysville 98271 60-659-0564
NAME
E ADDRESS
M Type B or L vent connectors
Niawred an Ame'll-b"En na a allances 11
CITY
I unheated spa"ce& i.1.7
NAME 16.� —
FAot—water Heater
ADDRESS
12601 132 Ave NE
CITY ZIP TELEPHONE
Kirkland 98034 �25-814-3124
STATE LICENSE NUMBER EXPIRATION DATE
FASTWHC052DF 2-16-05 14
PROPERTY TAX ACCOUNT PARCEL NO.
00458500000700
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
0 MULTIFAMILY
REPAIR
GRADING CYDS
0 DEMOLISH
TANK
oGARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. NESS
ot;r_-':�
OR ACTIVITY) EXPLAJN:
jhg-, a n
NUMBER
OF
RUMBER OF
DWELLING
UNITS
_STORIE;!W1//.7
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER4�V
JOB
SUITE/APT#
ADDRESS
7827 189th Pl SW
PLAT NAME/SUBDIVISION NO. —I
[6Tj�
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AMOVIDd
RW Permit Required
Street Use Peffnit Ra<d
EXISTING — PROPOSED
inspection Required
SideweA Required
REQUIRED DEDICATION— FT
UnderWound
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
I
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
ENGINEERING REVIEWED By BE ACCE"ED DATE
FIRE REVIEWED BY DATE I IUME,
VARIANCE OR Cu SHORELINEORADB# I INSPECTION BOND
BY 113 REO'D POSTED
I YES ONO 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
_KS IFT% PROPOSED SETBACKS (Fr.)
FPLUMBING / MECH LUI LJR SIDE REAR
XI ALLOWE D%'%j "PROuPO S E D FRONT SIDE REAR FRONT
COMPLIANCE OR
CHANGE OF USE
PARKING Nb,aMEWED BY DATE
El SIGN REOD PROVID CDC 19.30.020
EFENCE
] X FT) REMARKS SHALL big INSTALLm NEAR
OTHER
F RE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
in basement 40,000 btu's
or mosm, e
THIS 10 WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION: 160 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTEO WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF PIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, 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 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 C17Y AND STATE LAWS REGULATING CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (Owtffl OR7M DATE SIGNED
I
CHECKED BY ITYPE F ONSTRUCTION CODE OCCUPANT
GROUP 'e 3
SPECIAL INSPECTIOW OCCUPANT
REQUIRED 0 YES JAREIC LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
PIMILANT 110 11pC_
A WATER SERVICE SI=Fp
81hift jjq.S
VALUATION T Ink", . - __ --TALLED ON THE
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
EE
Recording Fee
Receipt #
CALL
FOR INSPECTION
1VA_ 9-5)
771-0220
APPLICATI PRovAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
/--N receipt Is acknowledged in space provided.
S SIG T E DATE
/1
RELEASED BY
ATTENTION CA 1 1 1313
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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