20040201.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
24207 89th Pl W
CITY ZIP I TELEPHONE
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME I C13L #
cc ADDRESS
0
�< 12601 132 Ave NE
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tj CITY ZIP TELEPHONE
0
6 Kirkland 9� 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I —,CHECKED IN
FASTWHC052DF 2 - 16 - _51 'iV P I
PROPERTY TAX ACCOUNT PARCEL NO.
00511700000800
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
F�
FENCE
( x FT)
DEMOLISH
TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINES"R ACTIVITY) MXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE W09K TO BE DONE
Remove.replace gas water heater in
utility room 40,000 btu's I
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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.
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W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS VHE Ciry OF
j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NAIURE, 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
01 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y 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 AGREETO 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 LABOR CODE OF THE STATE OF WASIIINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (OWNER OB77END)-- DATE SIGNED
PERMIT EXPIRES:jj:�L=
USE PERMIT
ZONE NUMBER
D2 JO
JOB
SUITE/APT#
ADDRESS
24207 89th Pl W
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
TESCP Approved
nw pa(mit Horitsifed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Street use Pajold Hoq'd
EXISTING — PROPOSED
inspection Required
sidewalk floquired
REQUIRED DEDICATION- FT
underground
wiring requilod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
REMARKS
Code. ECDC 19.30.
YES IJ NO 11
FIRE REVIEWEMRSUANTTO ECDC 19.30.028 ATE
A PRFMM RFGuLAmR VALVE=
VARIANCE OR
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVER)PM
ALLOWED PRORI[I.R11
PAR
REO'D I
REMARKS
A WISVEff @.'K%T.1 �, r FNWN
SIGN AREA
ALLOWED . PROPOSED
ON
BOND
POSTED
JNO IS
HEIGHT
ALLOWED . PROPOSED
) SETBACKS (FT.)
LIR SIDE REAR
DATE
CHECKED BY ITYP T U 10 E UPAN
GROUP
SPECIAL INSPECTION OCCUPAN*r
REQUIRED [] YES T� LOAD
0
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D z
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTI(
14251
FEE
,�2_0
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt # ><
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or his, 'tier Deptjty� and Fees are paid, and
receipt is acknowledged in space provioed.
lCift SIGNATIPE j__
�3ATE
771-0220
ATTENTION Bff 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
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD,ASSESSOR
z
0
4
0
M
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M
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0
10
0
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0
0
0 M
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0
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M
NS
RECORD OF INSPECTIO
INSPECTOR DATE APPROVED
SETBACKS� ......................
VOUNDATION:
Fboting ..........................
Wall ..........................
Pier/Porch ................. z
0
Retai.ning Wall .... * ...... 0
M
Slab Insulation ..........
PLUMBING:
M
Underground ..............
C M 0
Rough-Ir! . ................... 0
0
0C
Commercial Final —4 r.
M
M Z
HEATING:
C:
Gas Test .................... > z
Gas Piping .................
0 -n
Equipment .................. -n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING ..........................
0 M
CD
FRAMING........................
Q 0
Z
FIRST FLOOR FRAMING ... --I
INSULATION ................... ;U
--I
Floor Insulation ......... >
z
Wall Insulation ...........
0)
Ceiling Insulation .......
z
0
SHEETROCK NAILING ... --I
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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