20050515.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Janet Henry
w MAILING ADDRESS
0 955 Cedar St
CITY ZIP TELEPHONE
Edmonds 98020 425-670-2122
NAME
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it ADDRESS
16(j If
PERMIT EXPIRES
PERMIT
NUMBER u DOCD 0 Is 1�
JOB SUITEIAPT#
ADDRESS
955 Cedar St
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
PUBLIC �T il���i 5At(IGE�Y�red
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Fast Water Heater I�Vv ENGINEERINGREVIE EDB DATE
aO ADDRESS
�c 12601 132 Ave NE
Z CITY ZIP TELEPHONE FIRE REVIEWED BY UAO I V.1D w
Kirkland 98034
OBSERVED BY CITY INSPECTOR LU
425-814-3124
STATE LICENSE NUMBER IEXPIRATION DATE CHECKED BY VARIANCE OR CU SE
PA Z
COMPLETED EXEMPT Q .
FASTWHC052DF 2-16-07F AG
No 4r
-r PROPERTY TAX ACCOUNT PARCELNO. CAH ZONE SIGN AREA HEIGHT m
2 7 O 3 2 5 O O 1, O O8 O O WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW ❑X RESIDENTIAL ®xPLUMBING / MECH S1l �E�¢elr I1IDE REAR4 •1 O TB CKS AR �
ALL P OPOSPD FRONT $IDE REAR FRONT UR SID REAR c7 (n =
❑ COMMERCIAL COMPLIANCE OR on Uel_bUr ing appliances pa ing z m
T ElCHANGE OF USE Z C
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MiWkEVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ' a O C
❑ REPAIR ❑ GRADING ❑ FENCE M C
CYDS ( X FT.) REMARKS _
❑ DEMOLISH ❑ TANK ❑ OTHER m
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GARAGE RETAINING WALLFIRE SPRINKLER C Z
_ ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM r
a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPL IN:
I TYPE OF CONSTR CTION D OCCUPA
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02) GROUP
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NUMBER' NUMBER OF M
OF�% DWELLING I SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES !� UNITS LOAD OMNI
-r REQUIRED 13YES = C
DESCRIBE WORK TO BE DONE. I M m
REmOve' re lace gas Water heater REMARKS z 0
In Garage 40,*.000 btu' s GEOTECHREPORT m n M
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STRUCTURAL DESIGN t M 0
BY: Z 1--.
VALUATION
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Description FEE Description FEE Z
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Plan Check State Surcharge =
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge Z
0.
.PLAN C ECK NO: Plumbing Z. 00 Base Fee 1;2O , 06
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED,, THIS PERMIT COVERS WORK TO Mechanical m
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
t SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
Fire Review Plan Chk. Deposit
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p
UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i 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
(016100
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # of lY�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT -1 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 hislher Deputy: and Fees 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 space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27., FICIA SI E D TE
SIGNATURE (OWNER AG T): DATE SIGNED (425)
/%�'►� 6 6-28-05 771 -0220 REL ED BY D E
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 IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
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