20030720.pdf13
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
12arritz] a Stt-arn_-,
MAILING ADDRESS
8417 187 St SW
CITY ZIP TELEPHONE
Edmonds 98026 1425-775-9457
NAME
ADDRESS
CITY
ZIP
NAME CBL Of
Fast Water Heater 1w&
w ADDRESS
0
12601 132 AVe NE
CITY ZIP TELEPHONE
Kirkland 98034 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I CH;PT
FASTWHC052DP 2
PROPERTY TAX ACCOUNT PARCEL NO.
00567600000800
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAININGWALL
CARPORT ROCKERY
P
M?E OF USE, BUSINESS OR ACTWM EX ink
NUMBER NUMBER OF
OF DWELLING
STORIES I UNITS I
SCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
0 SIGN
ciFENCE
( _x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
PERMITE(PIRES
USE PERMIT
ZONE NUMBER
JOB SUIT6APT#
ADDRESS 8417 187 St SW
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
7ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PofrrJt ROQUIf6d
Street Use Permh Req'd
EMSTINQ - PROPOSED In.specWn R6quir
.. ___..,_!d
METE 6, Ljdf OF FIXTURE 13
49(2 NO C3 1;
IF- opfn pansion k E PRv "'T"'RED
requkhd an all hl! waleF Ifilil -1 5
z
REMAR z
OWNER RYAQQd'AESE= 4A390
ftTROLJDRAINAGI
IFIREJ:R
�SWW'Labor & Industries
VARIANCE OR CU SHORELINEORAD111 I INSPECTION 1$ BOND
REQ'D POSTED
C3YES ONO
SE�A REVIEW SIGN AREA HEIGHT
.T
COMPLE . E , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
in utility closet in laundry
room 34.000 btu's I
:D_O�R_OPOSED I FRONT
Type 11 orlL ve-s"
CHECKED BY TYPE
SPECIAL INSPECTION
REQUIRED [] YES
PER UBC
MPOSED SEIMACKS (Fr.)
RONT L/R S E REAR
tin z
D JA
OCCUPANT
GROUP
OCCUPANT
LOAD
INSPECTION REG'D
VALUATION
Nd A&d
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE _F__G WING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
_77
Mechanical
THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
It SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
CL PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:1 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
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
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 CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or 11131hor Deputy: and Fees are paid, and
IN VIOLATION OF THE LAD()R-GODE 0 THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSAT^�INVUE�ANCE AND RCW 18.27.
OFFICIALS PIG14AJURE
SIGNATURE (OPER i DATE SIGNED
(425)
V)ATE
4(
771-0220
ly
DATE
RELEASED BY
ATTENTION
Off 1333
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 YELLON- 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