20040099 (2).pdfA�F_DATL IIFCI'IVFO
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINFSS
MAILING'ADDRESS
8012 238th St SW
CITY ZIP TELEPHONE
Edmonds 91 425-775-9229
NAME
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t: ADDRESS
TELEPHONE
CITY ZIP
NAME CBLN
Fast Water Heater 7
cc ADDRESS
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12601 132 Ave NE
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CITY Z711 P TELEPHONE
80347
0 2[ -814-3124
0 Kirkland 98034 425
STATE LICENSE NUMBER EXPIFINUON DATE eRt!p
FASTWHC052DF 2-16-05 1(0
PROPERTY TAX ACCOUNT PARCEL NO.
00451900200201
NEW
RESIDENTIAL
_2_ADQITI�
COMMERCIAL
REMODEL
MULTIFAMILY
13
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACDYITy),F;XPLAIN
,�j
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIG14
FENCE
( x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER OF CRITICAL
OF DWEI LING AREAS
UNITS NUMBER
0 STORIES If !J—
Cn -NUMBER
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DESCRIBE WORK T9 BE DONE
f1\1 REmovelreplace gas water heater
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
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LOT SLOPE %
VESTED DATE
j PERMIT EXPIRES
, A/�, LY - - - I - i
US[: PERMIT
ZONE NUMBER Z,
SUITE/APT#
ADDRESS 8012 238th ST SW
PLAT NAME/SUBDIVISION NO LOT N 0
LID NO.
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LID FEE $
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13
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PUBLIC RIGHf OF WAY PER OFFICIAL STREET MAP
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Ex ROPOSED
ins action quired
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MEIV-0SIkIt LIN'E SIZE '0 OF FIXTURES
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IBODAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
in
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
in UIREMENT OF ANY CITY ORDINANCE
-ji DEEMED TO MODIFY, WAIVE OR REDUCE ANY REG
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
ENGINEERING REVIEWED BY
DATE
DATE
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FIRE REJE14ft B or L svc-vn,�- Ctox�s
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIO14
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.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABPA\,reODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAyqkINJURANCE AND RCW 18.27.
SIGNATURE (OWNER 04 dGENTj DATE SIGNED
T6Y[27S�Ol�j�s
SEPA REVIEW SIGN AREA
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP _LLi�
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (IT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING FLOT AREA �IPLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED fBY nTYPEO�ONSTFIUCT!�N OCCUPANT
ICODE d tGR Ou UU Pr
UZNL 71,
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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REMARKS
LPROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTIO REQ'D I z.
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description
State Surcharge
CALL
FOR INSPECTION
(425)
z;/10 �Lm 771-0220
ATTENTION 7 / E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPZICATION APPROVAL
This application is not a permit until signed by the
Building otiiciai or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
ATE
OFFICIALS SIGNATYRE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:'
'F60tifig .................
Wall . ............. : .........
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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