20050587.pdfDATE RECEIVED
FPERMIT EXPIRES
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CITY OF EDMONDS
PERMIT S$ 7
NUMBER
JOB SUITE/APT#
ADDRESS
CONSTRUCTION PERMIT APPLICATION
803 15 St SW
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUB DIVISION NO.
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LOT NO.
LID NO.
Barbara Bloom
LID FEE S
MAILING ADDRESS
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808 15 St NW
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425-672-4637
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12601 132 Ave NE
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CITY
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Kirkland
425-814-3124
VARIANCE OR CU
SHORELINE ORADEIM
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I INSPECTION
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COMPLETED
STATE LICENSE NUMBER EXPIRATION DATE
CHECKE48Y
FASTWHC052DF 2-16-07
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PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED PROPOSED
ALLOWED PROPOSED
00645800000900
STUDY 13
,
NEW
RESIDENTIAL
in PLUMBING/MECH
L T COVERAGE.
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
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PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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COMMERCIAL
COMPLIANCE OR
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MMI)DITION
MIXED USE
CHANGE OF USE
PARKING
REA
PLANNING REVIEWED By DATE
IL
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
SIGN
FENCE
( X FT,)
OTHER
FIRE SPRINKLER
FIREALARM
REO'D
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RE RKS
CODE
NUMBER NUMBER OF
OF Dv% ELLING SPECIAL INSPECTION CONSUL
STORIES UNITS REQUIRED YES
DESCRIBE: WORK TO BE DoNE
Remove replace gasd water heater REMARKS
in garage .40,101 -ut-u S
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
LUATION
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Description
Plan Check
HEAT SOURCE
LCITSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
9
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Engr. Review
I.-
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
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ININTE REST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
0
DEEMED
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.6
Recording Fee
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- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
IN VIOLATION OF
WORKMEN'S COMPENSATIOT�RANCE AND RCW 18:27.
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SIGNATURE (OWNE EN : DATE SIGNED (425)
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt 0
Total Amt. Duo
,
Receipt #
APPLICATION APPROVAL
This application is not a purnit until silned by tho
Building O"cial or N51hul DOPullif an(j ronsatti pai(i. ato
recolpi is acknowifidtlil III f.paco I'virividill
7-19-05
771 0220
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
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 I IBC110 I IRC110.
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