20040905.pdfDATE RECIIVED I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Rob/Jane HEnderson
MAILING ADDRESS
8904 192 St SW
CITY 0ZIP_ ITELEPHONE
Edmonds 98 26 425-697-6531
NAME
ADDRESS
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
IIESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street Use peone Recid
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Undelgroiind
Wiring required
METER SIZE I LINE SIZE I NO. OF FIXTURES
PRV REQUIRED
YES [3 NO 13
REMARKS
OWNER/CONTRAcTon RESPONSIBLE FOR EROSION C�QNTROL/DRAINAGE
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CITY ZIP
TELEPHONE
In addition to the —required
NAME
CBL ft
piessure/sitelief valve, all app,
Hyted ta"I.-
Fast Water Heater
ENGIJqERINGREVIEVfEDBY
---sh-fill-be—DAT
installed on all hot water tanks.
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ADDRESS
12601 132 Ave NE
*W11121
FIREUA.107 �D DA
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CITY ZIP
TELEPHONE
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Kirkland 98034
A 14-3124
VARIANCE OR CU
SHORELINE OR ADB#
INSPEC�ION
Fit _QD
OYES ONO
BOND
POSTED
S
STATE LICENSE NUMBER EXPIRATION DATE
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FASTWHC052DF 2-16-0
xx8xN19x tX
X Yt
CHECKF BY
SEPA REVIEW
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED I PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO. Ij
27041800303600
NEW FRI RESIDENTIAL 12 PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
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GRADING FENCE
REPAIR CYDS ( X FT)
LOT COVERAGE
Al-PaD _pAQM§9Q_
IType B or L
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
quired
vent Connectors i
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evnvaeft BY M
s4volf, IMC 803.2
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ROMARKAE-_—:":��--"
OTHER
DEMOLISH TANK
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT PACKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR A 11 Ex IN
\P, IS
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CHECKED BY
ITYPE OJJSTRU
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OCCUPANn
GROUP
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NUMBER
OF
STORIES I
NUMBER OF
DWELLING
UNITS I
CRITICAL :q f��
AREAS
NUMBER
SPECIAL INSPEGTIUN
REQUIRED YES
jAhLA
OCCUPANT_,--�
LOAD
DESCRIBE WORK TO BE DONE
Remove/replace gas water heater
REMARKS
PROGRESS INSPECTIONS PER UBC loa/IBC109/IRC109 FINAL INSPECTION REC'D
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in garage 38,000 btus
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LUATION
M6,K )xr],
Lk_-221 PL7
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
Base Fee
ECK NO: VESTED DATE
Mechanical
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.
Grading
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIFY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
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
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
APPLICATION APPROVAL
CALL I his application is not a permit until signed by the
BUilding Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION- receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18�27.
0 IC LS SIGNATURE DA
(425)
R
771-022 EASEI)7Y ATE
SIGNATURE (OWNE AGEN
DATE SIGNED
ATTENTION
E)ff 1333
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC11l0-
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 ............ I .......
Commercial Final ......
HEATING:
Gas Teit
........... ........
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
AVA717
MISCELLANEOUS ..........
FINAL APPROVAL FOR LA t-cs
OCCUPANCY ..................
400'
20C?qww0q05
The initials MT are Milton
Thorripson, a temporary contract
inspector for the CitY.
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