20050019.pdfDATE RECEIVED
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CITY OF EDMONDS
C CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
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Anderson, Jim
LM MAILING ADD7RESS
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9314 94 Ave W
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CITY ZIP TELEPHONE
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Fds 98020 425-778-7370
1 1 NAME
ADDRESS
CITY
ZIP
TELEPHONE
PERMIT EXPIRES jWc�al_)
USE PERMIT
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NUMBEI�.4//��_
JOB SUITE/APT/
ADDRESS 19314 94 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
Street Use Permit Roq'd
EXISTING — PROPOSED
inspection Required
Sidewalk Haquirod
REQUIRED DEDICATiON_ FT
Underground ad
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
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NAME
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Fast WAter Heater
ENGINEERING REVIEWED BY DATE
A DDRESS
12601 132 Ave NE
FIRE REVIEWED BY DATE
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CITY ZIP
Kirkland 98034
TELEPHONE
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F425-814-3124
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUM13ER EXPIRATION DATE
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FASTWHC052DF 2-16-0
OYES ONO
1$
SEPA REVIEW
COMPLETE EXEMJPTiALLOWED
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EXP
SIGN AREA
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HEIGHT
ALLOW PRO POSED
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PROPERTY TAX ACCOUNT PARCEL NO.
00434600006005
NEW RESIDENTIAL Rk PLUMBING MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIR SIDE REAR
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PARKING
REQ.D I PROVIDED
LOT AREA
J.PLANNING REVIEWED BY DATE
REPAIR GRADING CYDS FENCE
X —Fr)
REMARKS
DEMOLISH TANK E] OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUrS OR ACTIVITY) EXPLAIN:
CHECKED BY
ITYP
CODE
OCCUPANT
GROUP/
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NUMBEEL
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NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED E] YES
JAREA
OCCUrANT
LOAD
-3
DESCRIBE WORK TO BE DONE
Remove/replace gas water heater in
REMARKS
PROGRESS INSPECTIONS PER ILIBC 108/[BC109/[RC109 FINALINSPECTION REO'D
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basement furnace room 70,000 bitu's,
I)rpe D or L vent connectors required
on fuel -burning appliances passing
VALUATIGAUTUu
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Description
FEE
Description
FEE
Plan Check
state surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
Base Fee
PLAN CH ECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPEIM ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURaS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receint #
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
CALL
FOR INSPECTION
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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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SIGNATURE (7hO
DATE SIGNE . D
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771-0296%o
RELEASED BY �IATE
A17ENTION Off 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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