20040812.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Nancy Brancheau
MAILING ADDRESS
22616 105 Ave W
CITY - ZIP ITELEPHONE
Edmonds 98020 425-774-2765
NAME
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CITY ZIP I TELEPHONE
0 1 NAME
Heater
CBL
ADDRESS
12601 132 Ave NE
CITY ZIP
TELEPHONE
Kirkland
1425-814-3124
STATE LICENSE NUMBER
EXPIRATION DAT
CHEC Y
FASTWHC052DF
2-16-05
PROPERTY TAX ACCOUNT PARCEL NO.
00610400001 600____
NEW RESIDENTIAL
Q< PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
D CHANGE OF USE
REMODEL MULTIFAMILY
El SIGN
F� GRADING FENCE
REPAIR r. y ns El ( X FT-)
DEMOLISH TANK
0 OTHER
oGARAGE RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
(TYPE OF USE, BUSIN OR ACTWI�M
V01—
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
aas
water heater in
loset
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
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 LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 130 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, 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
ALI. CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIRECTLY OR INDIRECTIN
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
NOR LIMIT IN ANY WAY THE CITYS ABILITY 70 ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA1 ION. 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 18.27.
SIGNATURE (OWNER OR AG DATE SIGNED
_RMIT
) 7
EXPIF___f
P E I ES
USE PERMIT
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NUMBER
(312".
JOB
SUITE/APT#
ADDRESS
22615 105 Ave W
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
E3
[3
Street Use Permit Raq'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
[3
REQUIRED DEDICATION— FT
underground
wiring required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESE3 NO 13
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REMARKS
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OWN ERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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presgure/refiefs v-1veg an approvela
Cs
listed expansion tank shall be
ENGINE 16ffiflMl6n all hot water tantN��TE
FIRE DATE uj
VARIANCE OR CU SHORELINE OR ADBI INSPECTION BOND
REO'D POSTED
[1YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (F-T.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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KING LOT AREA I PLANNING REVIEWED BY DATE
yREO'D PROW [ED
PC
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11kPitigillillitleatedswic 11VIC303.2 I
CHECKED BY ITYPE OF CON.WTION
ROUP
SPECIAL INSPECTION R EM j OCCUPANT
REQUIRED E] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 If IBC109/ IRC109 FINAL INSPECTION REO'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description
State Surcharge
City Surcharge
Base Fee
/6
(425)
771-0220 --R
FEE
Plan Chk. Deposit
Receipt III
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
FrILAV JIGNATURE11 — /ATE
A17ENTION If t:)k I I did V
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBCI10/lRCI10.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ED BY
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...........
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underqround .............
Rough -In ...................
'Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
Equipment ................. 4
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
bj
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Illitials MT are Miltol,
Thompson, a temporary contract
inspector for the City.
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