20040708.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Paul Clampitt
MAILING ADDRESS
7721 168 P1 SW
CITY ZIP TELEPHONE
Edmonds 98026 1425-775-4139
NAME
USE
ZONE
JOB
ADDRESS
PERMIT EXPIRES L
PERMIT
NUMBER
SUITE/APT#
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
IFISCP Approved
E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW permit Required
13
street use Permit Req'd
0
EXISTING - PROPOSED
inspection Required
Sidewalk Required
E3
E3
REQUIRED DEDICATION- FT
Underground
wiring required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
'IV OU
PFIV REQUIRED
7Y
Es C3 N10
t'j ADDRESS
x
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cc
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CITY ZIP I TELEPHONE
NAME
Fast Water Heater
ADDRESS
12601 132 Ave NE
CITY ZIP
TELEPHONE
Kirkland 98031 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I _QHECKI
FASTWHC052DF 2-16-0K_,Wb
CBL 0
PROPERTY TAX ACCOUNT PARCEL NO.
00752000000200
F1
NEW
RESIDENTIAL
MXADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
I[TYPE OF USE, BUSINESSQa.,ACTIVITY),,EXF?tAIN:
i-n
Lu NUMBER 'NUMBER OF
0 OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
all
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
[2XPLUMBING / MECH
El
COMPLIANCE OR
CHANGE OF USE
17
SIGN
IFENCE
I
( X FT,
13
OTHER
FIRE SPRINKLER
FIRE ALARM
REMARKS
OV#46RjCOWW,T.Q&,2.E��0N�IBLE FOR EROSION CONTROLIDRAINAGE
ilk; 1, VOW
"Afficatef! spar -Pic, I N11 C 803.2
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU _J�HORELINE OR ADB# INSPECTION PBOND
REO'D OSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I LLi_
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
REQ'1
REM�
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DATE
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AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED [] YES LOAD
ter heater IREMARKS z
PROGRESS INSPEC71ONS PER UBC 1108/ IBC109/ IRC109 FINAL INSPECTION REQ'D S
M
S M
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS 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 DIREC FLY OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMI1 SHALL NOT HE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 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 WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 1827.
SIGNATURE (OV OR N DATE SIGNED
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
0
Recording Fee
Receipt #
016,5;L,
CALL
FOR INSPECTION
(425)
771-022 0
APPLICATION APPROVAL
This application is not a perrinit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
rriceipt is acknowledged in space provic�pd.
OF 1 1. SIGNATUR DATE
nvAsEl) BY DATC
ATTENTION t:A I
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR ACERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/lBC110/lRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
'FOUNDATION'
j.
Fooif ......
Wall............ * ...............
Pier/Porch .................
Retaining Wall ...........
Stab 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 ..................
2& Vw 6 w/to 8, %/
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