20050435.pdfDATE RECEIVED • r
Ll /o1 PERMIT EXPIRES
CITY. OF EDMONDS NUMBER (;2 — -k3
CONSTRUCTION PERMIT APPLICATION JOB�g� SUITEIAPT#
ADDRESS 0�.'
OWNER NAMEINAME OF BUSINESS L
Randall Tdeker
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS LID FEE S
3 PUBLIC RIGHT OF ^AP�j.TESCPA provaC ❑
0 18020 Home View Dr -w••.w Reeeeetl ❑
a • • SVoot Us Permit Required ❑
CITY 21P TELEPHONE EXIS n rF'[i1111'tE[i
t$j�[(1r;gyp tg,gj,�y Inspucun Required ❑
Edmonds 9E026 4.25-672-1 031 REQ„ i Ik egmred ❑
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OWN C'jESPONSIBLE FOR EROSION CONTROUDRAINA E
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CITY ZIP TELEPHONE
NAME CB
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Fast Water Heater ENGINEER ATE
o ADDRESS AFFIDAVITS SHALL NO
12601 132 Ave NE
FIRE REVIEWED BY St ACCEPTED DATE . W
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Kirkland 98034 425-814-3124 LL
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB#SPECTION SEPA
Rr�EQ'D COMPLETED EXEMPT
FAS1Nv-HC052DF 2-16-07 P SUANT TO U;- YQ
—I PROPERTY TAX ACCOUNT PARCEL NO. OA# WA'1' S VI 's HEIGHT
WAIVER O jg L BE IN 'i11a►1 Fi)NE LOWED PROPOSED
OD STUDY D&4Z IT 14N BUILID (j
❑ NEW RESIDENTIAL®{ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
❑ COMMERCIAL COMPLIANCE OR Z
1:1 MIXED USE ❑ CHANGE OF USE ; ` z
REMODEL PARKING LYO{�itEs N�t� 1%M (PRVAATE g
❑ REQ'D PROXI# Ti i' fU�1
❑ MULTIFAMILY ❑ SIGN [[iiYY ` "' ' NF R
FENCE
❑ REPAIR ❑ GRADING CYDS ❑ X FT.) REMARKS y,r,
❑ DEMOLISH ❑ TANK ❑ OTHER
Z 1:1GARAGE FIRE
CARPORT ❑ ROCKE YG WALL ❑ FIRE ALARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXIt4
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• 1 DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES l r�JP/ UNITS LOAD
REQUIRED 13 YES .
DESCRIBE WORK TO BE DONE
Remove replace gas water. heater REMARKS ""'""°^"'^' ""•^�r"^*��•^�w•' c7
:Typa F' rw 1, vent connectors reguiredo
lean room off garage 40,000 btu's GEOTE H Q
BY: q: 1-Iiu�r.jIlcr ap�piaances /passing
STRUC • 1611411 1 unficated spaces. LWC 8012
BY:
( VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE / rl
Building Permit City Surcharge QV
PLAN CHECK NO: Plumbingr pv Base Fee U
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading
7 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
Engr. Review
or PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Mill -
Engf. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire RBVICW Plan Chk. Deposit
.UJI
jIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 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 BE /
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp.Total Amt. Due (V
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt it
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 AGENT OF This application is not a permit until signed by the
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fres are paid, and
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 FOR INSPECTION receipt is acknowledged in spare provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS&IGNATNAT A*L_�w � ( TE
SIGNATURE (OWNER OR ENY , DATE SIGNED (425)
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771 -022 RELEASE Y DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC1101 IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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