20040584.pdfDATE RECEIVED ._-7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ellen Perrin
MAILING ADDRESS
21232 Shell Valley Rd
CITY ZIP I TELEPHONE
Edmonds 98026 425-778-3069
NAME
ADDRESS
CITY
ZIP
NAME
Fast Water Heater
ADDRESS
12601 132 Ave NE
CITY ZIP
Kirkland 98034
STATE LICENSE NUMBER
FASTWHC052DF
PROPERTY TAX ACCOUNT PARCEL NO.
00649900001900
TELEPHONE
CBL a
TELEPHONE
4 2 5- 814 - 312 4
EXPIRATION DATE M
2-16-0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINE"%PRjACTIVITj EXPLAIN
NUMBER NUMBER OF
OF I DWELLING
STORIES NITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PERMIT EXPIRES
PERMIT
N1
JOB
ADDRESS
21232 Shell Val'.
PLAT NAME/SUBDIVISION NO. T=OTNO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
I ESCP Approved
13
RW Pernut Required
(3
Street Use Permit Roq'd
(3
Inspection Required
E3
Sidewalk Required
13
Underground
Wiring required
El
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CON1RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
��l
N ENGINEERING REVIEWED BY DATE
BY
:0
PLUMBING / MECH
1:1
COMPLIANCE OR
CHANGE OF USE
1:1
SIGN
IFENCE
( X F1)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
room 36,000 btu's
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc
ILL! PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
tun) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
�j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREc rLY 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
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
FIRE REVIEWED BY DATE W
cc
ILL
VARIANCE OR CU HORELINEORADEIN I INSPECTION
0Y I BOND
REO'D POSTED
ES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
RED
REM
9 1 9.
CHECKED BY ITYPE
N
19 t$ oj- 1, venit colfincdors
fuel-burnimil: Annlinma 13A.qg
DATE
OCCUPANT
GROUP
FEE Description
State Surcharge
City Surcharge
Base Fee
N REQ'D
1 :3
M
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due T�_
Receipt #
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 APPLICATION AP"6VAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a perinit until signed by the
�Y CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged III space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27, OFFI 'IAI23IGNAI URF '/ D AIE
SIGNATURE (OW� R OR VEN,_Q DATE SIGNED (425)
-7 C
NWANWM� I i?__1 --- ?/1 771-0220 R/ AS
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED, UBC109/IBC110/'IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
l _" . I
t j
By
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
z
5
01.
4
z
0
1
0
M
-i -n
0 M
C
M 0
40
0
0 C:
M
M Z
04
C: _z
(n
0 _n
n x
>
M M
0
0
0 M
C: Cn
9 [n
M 0
Z
7-1
r
z
--i
M
Z5
z
0
1
0
M
11
RECOR OF INSPECTIONS
INSPECTOR DATE APPROVED
SErBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ...... .
HEATING:
Gas Test ....................
Gas Piping .................. ... ...
Equipment...................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
..........
FIRST FLOOR FRAMING:..'!'.
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR Pol
OCCUPANCY ..................
zoo (/., 05no
z
0
0
5i
M
C
M 0
0
--i (-)
0 C:
—4 K
:E M
M Z
jo
C
3:
Cn
0 -ri
-n
3:
M M
0
0
0 M
C Cl)
9 Cn
M 0
Z
z
Cf)
z
0
`1
0
ITI