20050020.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Gong, Brad & Paula
MAILING ADDRESS
7307 176th St SW
0
CITY ZIP TELEPHONE
Edmonds 98026 1425-787-6766
1 NAME
ADDRESS
CITY ZIP I TELEPHONE
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
7 3 0_T__1 7 6 5f- Sjg
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TFSCP Anoroved
BW Permit Required
E3
0
Street Use Permit ROU'd
13
EXISTING — PROPOSED
inspection Required
C3
Sidewalk Required
E3
REQUIRED DEDICATION— FT
Underground
Wiring required
METER SIZE
LINE.SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME
CBL4
Fast Water Heater
ENGINEERING REVIEWED BY DATE
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ADDRESS
12601 132 Ave NE
FIRE REVIEWED BY DATE
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CITY ZIP
Kirkland 98034
TELEPHONE
425-814-3124
VARIANCE OR CU
SHORELINE OR ADB#
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INSPECTION
REO'D
OYES ONO
BOND
POSTED
S
STATE LICENSE NUMBER EXPIRATION DATE
FASTWHC052DF 2-16-2t
CHECKEP By
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED I PROPOSED
9
PROPERTY TAX ACCOUNT -PARCEL NO.
00456000 01500
NEW 10 RESIDENTIAL PLUMBING MECH
COMPLIANCE OR
ADDITION COMMERCIAL
1:1 CHANGE OF USE
REMODEL 1:1 MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
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PARKING
REQ'o I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
[3 GRADING CY FENCE
REPAIR DS X —FT)
REMARKS
DEMOLISH 1-1 TANK OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 13 ROCKERY FIRE ALARM
(rYPE OF USE, BUSINESS O�tCTIVITY) EXPLAIN:
CHECKED BY
T] RUC�ION
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OCCUPANT
GROUP
0
NUMBER
OF
STORIE
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED [3 YES
LOAD
DESCRIBE WORK TO BE DONE
Remove/replace gas water heate
REMARKS z
PROGRESS INSPECTIONS PER LIBC 108/ ISC109/[RC109 FINAL INSPECTION REO'D
in first floor utility closet
40,000 btufs
Type B or L vent connectors required
VALUATIC
Illances passing
Ring appi
$ ti Vug
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Ileasod
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
Base Fee
PLAN CHECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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CL
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 190DAYS
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
'APPL . ICANT, 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 AGENI'S FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFN� WAIVE OR REDUCE AHY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp-
Total Amt. Due
Recording Fee
Receipt #
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
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 This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes arc paid, and
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
?FI ALS S N TURE DATE
(4,25)
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SIGNATURE
DATE SIGNED
1-7-05
771-0220 —RE&AVI) BY DATr
ATTENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEENGRANTED. UBC109/IBC110/IRC110.
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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