20040756.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
Lana Anderson
MAILING ADDRESS
8417 Main St #A
CITY ZIP TELEPHONE
Edmonds 98026 1425-775-6573
NAME
ADDRESS
CITY ZIP [TELEPHONE
yq/
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
;t #A
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- F-F
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
street Use Permit Req-d
Inspection Required
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 0 NO 13
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NAME CB $11
DATE
'Fast Water HP.Flter Ll ENGINEERING REVIEWED BY
a: ADDRESS
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12601 132 Ave NE FIRE REVIEWED BY DATE uj
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CITY ZIP EPHONE rL
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0 Kirkland 98034 4 2 5-814 - 312 4 BOND
___I TEL VARIANCE OR CU SHORELINE OR ADB# INSPECTION I
STATE LICENSE NUMBER EXPIRATION DATE CHECrD BY REO'D POSTED
FASTWNC052DF 2-16-05 1 OYES ONO $
SEPA REVIEW SIGN AREA HEIGHT
_V COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
PROPERTY TAX ACCOUNT PARCEL No.
UJI 00647400500100 EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR C)
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE z
PuK M"Jftd.VIEWED 13Y DAT:E:: I
f1ja NY trk� 01.
REMODEL MULTIFAMILY SIGN R rCrED
re/r lief va e. an a
REPAIR GRADING FENCE nftr SSU 7p— . =
CYDS X FT) -,nnk. hall bP
"ris'fe ! expar]SiOil tin nk shall be
OTHER
El DEMOLISH 11 TANK F1 installed- org all hot water tanks.
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT 13 ROCKERY El FIRE ALARM UPC 608
= (TYPE OF USE, BUSINES OR ACTIVITY) IJXPLAIN:
'TION OCCUPANT
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3CR;OUP
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NUMBER NUMBER OF CRITICAL OCCUPANT
W I AREAS
OF DWELLING i //A LOAD
0 STORIES UNITS NU
DESCRIBE WORK TO BE DONE
Remove/replace gas water heater REMARKS z
PROGRESS INSPECTIONS PER LIBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
in bedroom closet 38,000 btus
LUATION
E P-6 T1. $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
I — —4 9r)
HECK NO: VESTED DATE Plumbing Base Fee 0
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due 0 2
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording ee Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPEICATIO - N APftAOVAL
F
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER, I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_ CALL Building Official or his/tier Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 0 FIC
,JAV SIGNATURJ� �AT(:/ III
SIGNATURE (OWNER OR GEN DATE SIGNED (4:25)
7
771-0220 j*EASED BY PATE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED, UBC109/]BC110/IRC110. 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:
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 ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
AC
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