20050704.pdfDATE RECEIVED.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Lai Wong
MAILING ADDRESS
16108 SE 45th St
CITY ZIP TELEPHONE
Issaquah 98027 425-444-7888
NAME
ADDRESS
CBL#
PERMIT EXPIRES
P P RMIT
MIT
N UM
UMBER
JOB
ADDRESS
1 7621 200 St SW
Fast Water Heater
ADDRESS
12601 132 Ave NE
CITY ZIP ITELEPHONE
Kirkland 98034 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
FASTWHC052DIF 2-16-07 . V"41
PROPERTY TAX ACCOUNT PARCEL NO.
008596.00062100
NEW
RESIDENTIAL
ADDITION
13
COMMERCIAL
1:1
MIXED USE
REMODEL
1:1
MULTIFAMILY
REPAIR
[:]
GRADING CYDS
DEMOLISH
F]
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINES5 OR ACTIVITY) EXPLAIN/)
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
SUITEIAPTN
PLAT NAMEISU B DIVISION NO.,
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TES,:PApproI [3
13
RW Permit Required
Street Use Permit Requited (3
EXISTING PROPOSED
Inspection Required [3
Sidewalk Requited [3
REQUIRED DEDICATION FT
[3
0
PRV REJUIRED
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ENGINEERING REVIEWED BY DATE
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REMARKS
OCCUPANT
GROUP
NUMBER
OF
STORIES
NUMBER OF
DWELLING
I UNITS
-1 V - % -
SPECIAL INSPECTION
REQUIRED
CONSULTANT
. % I
OCCtTPANT
LOAD
DESCRIBE WORK TO BE DONE
Remove/replace gas water heater in
REMARKS
garage 40,000 btu's
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
$
.0
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOI
OA&4�
E%
VESTED DATE
1
Build I Ing Permit
City Surcharge
Z5, 010
PLAN CHE�lk NO:
Plumbing
6 01)
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT 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, HE . IRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Review
Plan Chk. Deposit
Fire Inspection
Landscapelnsp.
Receipt #
Total Amt. Due
(CIS. DO
Recording Fee
Receipt #
LIE 1"g.
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 CONSTRUCI,
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy. and Feesare paid, and
receipt is acknowledged in space provided
FF AI � Ad
�PNAI Vj DATI A r
SIGNATURE (OWN GENT,
DATE SIGNED
B-016-05 771-0220 RELEA
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. UBC1091 IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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