20050088 (2).pdfDATE RECEIVED
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PERMIT EXPIRES
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USE PERMIT
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NUMBER
CITY OF EDMONDS
7
CONSTRUCTION PERMIT APPLICATION
JOB SUIrE1APT#
ADDRESS
19819 77 Pl W
OWNER NAME/NAME OF BUSINESS
1
PLAT NAME/SUBDivisloN NO.
LOT NO,
LID NO.
Steve Thomas
U1 MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP "Proved a
FiW Permit Roqu pit
19819 77 Fil W
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Street Urie Point:; Hort d
CITY ZIP TELEPHONE
EXISTING - PROPOSED
Inspriction (Inctulied
SP.10WOlk ROqUiffti
Edmonds 98026 42R 206-427-3188
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REQUIRED DEDICATION- FT
Undo(gratind
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES13 NO 0
U9
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ADDRESS
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OWNE qP rAIIA2g4h6013 N ��IROL/DRAINAI iE
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CITY ZIP TELEPHONE
iagurelrellef:valvie, an approxed
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ligted expansivirii -."mk shall be
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installed on all hot water tanks.
NAME CBL#
ENGINEg"FelEgf"Y DAJTE
FAst Water Heater
CC ADDRESS
0
12601 132,Ave NE
FIRE REVIEWED BY DATE
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CITY PHONE
ZIP TELE
0
Kirkland 98034 425-814-3124
VARIANCEORCU
SHORELINE ORADB#
INSPECTION
BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
REO'D
POSTED
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$
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SEPA REVIEW
SIGN AREA
HEIGHT
_j PROPERTY TAX ACCOUNT PARCEL NO.
UUMPLE I E. EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
00564000001500
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EXP
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
0 NEW UKRESIDENTIAL )ER PLUMBING I MECH
COMPLIANCE OR
ADDITION COMMERCIAL
El CHANGE OF USE
0
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL 0 MULTIFAMILY SIGN
REO'D I PROVIDED
0 REPAIR El GRADING CYDS FENCE X FT)
REMARKS
OTHER
DEMOLISH tAN K
o GARAGE RETAININGWALL FIRE SPRINKLER
El FIRE ALARM
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(TYPE OF USE. BUSINIE, Oil ACTIVITY) EXPLAIN:
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CHECKED BY
TYPEWO STRUCTION
COQE
OCCUPANT
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GROUP
NUMBER rN ICAL
OF < D UA is
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SPECIAL INSPECTION
AREA
OCCUPANT
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0 STORIES NI BER
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
Remove/renLace qas water heater in
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
9
u tility closet under stairs 40,000
VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOU RC�_7 GLAZING . LOT SLOPE I %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
%
Plumbing
Base Fee
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
Grading
DOMAIN JCURBS, SIDEWAL.KS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IE ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
LL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENr OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SSI TURE QATE
SIGNATURE (OWNER'dil DATE SI ED
(425)
�IL4, � Al
771.0220
lim - - I
it ECEA66 B DAX
ATTENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR 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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