20050589.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Sandra Nelsen
MAILING ADDRESS
21404 84 Ave W
CITY ZIP TELEPHONE
Edmonds 98026 1425-712-0428
NAME
,2_0 10 ') I I PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITEtAPT#
ADDRESS
21404 84 Ave W
PLAT NAME!SUBDIVISION NO. LOT NO. LID NO.
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 13
RW Permit Required E3
Street Use Permit Required C3
EXISTING PROPOSED I Required Q
Sdow X Required E3
rum riund
RE2L49"DE'Cl gired— iauiurd
m0ws'liff", Ll ed
F§IftftN RV REQUIRED
e�N afi
pressu YE 13 NOM
UAR Uj
R W
0 RESP?I`flIj0 *mtkwRAIN E z
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Fast Water Hea ter L
2z W.-
ADDRESS
12601 132 Ave NE
CITY ZIP TELEPHONE
Kirkland 98034 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
FASTWHC052DF 2-16-07
PROPERTY TAXACCOUNT PARCEL NO.
00486600001600
ENGINEERING REVIEWED BY
ol, 1, velit connectors required
FIRE F6el"dMunting, appliatices passing DATE
through unheated spaces. IAIC 803.2
SHORELINE OR ADB# INSPECTION
VARIANCi70W_dU St
REO'D 01 COMPLETED I EXEMPT
10YES 13N
CA# ZONE SIGN AREA HEIGHT
WAIVERO ALLOWED ROPOSED ALLOWED PROPOSED
STUDY 0 1 1 1 1
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NEW
ADDITION
)P9 RESIDENTIAL
COMMERCIAL
MIXED USE
KI -PLUMBING/ MECH
COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
`nwruQuuQPm k )
FRONT L/R SIDE. REAR
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PARKING
LOTAREA
PLANNING REVIEWED 13Y DATE
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REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
E] ROCKERY
SIGN
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIRE ALARM
REQ D
i FIR . OVIDED
REMARKS
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(TYPE OF USE, BUSINESS ORACTIVITV) EXP N:,
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TYPE2100IMT1,
NUMBER OF
OF DWELLING
NUMBER V ---
STORIES I UNITS
DESCRIBE WORK TO BE DONE
SPECIXL INSPECTION
REQUIRED 13YES
Removeireplace gas water heater—
REMARKS
in garage 40,000 btu's
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
No
h)JlAAJ
F 1'� 01 IVA —VALUATION
$
Description
Plan Check
HEATSOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W
0.
PERMI r APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
x
Fire Review
(11
V)
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Fire Inspection
Landscapelnsp.
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
CONSULTANT
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSAIggEINRANCE AND RCW 18:27.
SIGNATURE (OWNER 0 AGENf): DATE SIGNED (425)
rZ 2-13-05 771-0220.
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
DA
RELEASEJ� '
ATTENTION AL IJJJ
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. UBC109 / IBC110 I IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......... ...........
Wall...........................
Pier/Porch .................
Retaining Wall ..........
'-.'Slab Insulation ..........
PLUMBING:
M
Underground ..............
M
0
Rough -In ...................
0C
Commercial Final ......
IT!
M z
HEATI.NG:'
C
Gas Test ....................
ca.
Gas Piping ..................
0 n
...................
-n
Equipment
ITI
Commercial Final .......
M
co
EXTERIOR SHEATHING
�0
0 r, - �' I
ITI
NAILING .......................... .
C
C OY
FRAMING .......................
M 0
Z r
FIRSTFLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
01
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................