20041015.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Lcr MAILING ADDRESS
u
z
0 17211 Sea Lawn Place
CITY ZIP ITELEPHONE
EDmonds 98026 J425-776-2344
NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME FAst Water Heater CBL 0
ADDRESS
12601 132 Ave NE
USE
ZONE
JOB
ADDRESS
17211 Se
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER
SUIT
awn Pla
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISFING— PROPOSED
REQUIRED DEDICATION— FT
JIM Affidd jt�ojjNfi 111flie �effijilpedUREI
-A
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installed on all hot water tanks.
UPC 608
_-32,11 ENGINEERING REVIEWED BY
CITY ZIP TELEPHONE
Kirkland 98034 4 2 5- 814 - 3124
STATE LICENSE NUMBER EXPIRATION DATE CHnBY
FASTWHCO52DF 2-16-05
PROPERTY TAX ACCOUNT PARCEL NO.
00566200000800
NEW
Ea
RESIDENTIAL
ADDITION
F]
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
r.APPnRT
RETAININGWALL
ROCKERY
(T-YPE OF USE, BUSINESS OR ACTIVITY) E�XgLAIN
XFXI
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
Fr)
x
OTHER
FIRE SPRINKLER
FIRE ALARM
LID NO.
LID FEE $
TESCP Approved
RW Permit I'loquil
street use Permit
Inspection Requir
sidewalk Require:
Underground
Wumnloquired
IRI RED
YE 0
NAGE
DATE
FIRE DATE
Fll�*RIRWR r REG [Tj
_'ATOR VA-nT (Pav,
STIALLBE mis WILY'vy) It "
VARIANCE OR cu INSPECTION
REQ'D
OYES ONO
Fr-
SEPA REVIEW SIGN AREA FT
COMPLETE , EXEMPT ALLOWED . PROPOSED I ALLOWED
EXP
LOT COVERAGE
ALLOWED PROPOSED
CHECKED BY ITYPE
NUMBER NUMBER OF CRITICAL I —
SPECIAL INSPECTION
OF DWELLING AREAS
M UNITS NUMBER REQUIRED
0 STORIES � I YES
DESCRIBE WORK TO BE DONE
r
in aaracte 40,000 btu
HEAT
SOURCE GLAZING % Lor SLOPE %
PLAN CHECK NO: 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: 180DAYS
PERMIT LIMIT 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 DIRECTLY OR INDIRECT I-Y
FROM THE ISSUANCE OF rHIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CrFYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
1 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 COM PEN SATI-D"rqU RANCE AND RCW 18.27.
SIGNATUREAWNER ORVGENT) DATE SIGNED
REQUIRED SETBACKS (FT.) I PROPOSED S
FRONT SIDE REAR �IFIONT L/R
a
OCCUR
GROUP
OCCUP
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED UBC109/IBC110/IRC110.
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 9
Total Amt. Due
Receipt #
APPLICATION APPF
I his application is not a pernnit until!
Building Official or histlier Deputy: and F
receipt is acknowledged in space
OF
REIEASED
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW -
PINK -OWNER GOLD-,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
Retaining Wall ...........
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 ..................
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