20050967.pdfDATE RECEIVED ,�--(-)7 � 65
�. (U FPERMIT EXPIRES
CITY OF EDMONDS NUMBER -
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS
OWNER NAME/NAME OF BUSINESS 1047 BE l l St
Jan*t Nilsen PLAT NAMEISUBDIVISION NO. LOT NO. LID NO
lX MAILING ADDRESS LID FEE 5
w
G PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP- TESCP Approved
1 047 B O
ell S t RW Perms Required o
Sheet Use Pormir Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED _ Inspection Required O
Sidewalk Required O
Edmonds 9802 0 425-771-8832 REQUIRED DILATION "^'-- •- r.T:...� Undergrountl a
—�� - o
NAME METER SI ton thiepregUi i7, PRV RE IRED
pr sure/rel/ v YES I] NO 0 W
ruxted Lu
C ADDRESS REMARKS 408
' z
OWNERICO 'MAG'Il1MR,IBkIE�76y{IJ�INAGE
a Il a s"C 'Al 91 I hOt Water tanks, W
CITY ZIP TELEPHONE V fp
NAME CBL#06
FAst Water Heater 7i
ENGINEERING RSI IAED`bY dA'r
ADDRESS `r1tiA i11C,Iwliti )iii°+ F3SD�Lf[lle�'rllti:;a I�:i4$itl�
U
12601 132 Ave NE
�C CITY ZIP TELEPHONE FIRE REVIEW D BY ' DATE w
O LL
Kirkland 4 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
FASTWHC052DF 2-16-07 OYES ONO
-� PROPERTY TAX ACCOUNT PARCEL NO. CAN ZONE SIGN AREA HEIGHT
WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED
Lu
00434204102300 STUDY O
❑ NEW ® RESIDENTIAL ® LIMB G / MECH LOT COVERAGE __-E OPOSED SETBACKS (FT.)
ALLOWED P p����y� RONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR G""r=+••R� `/ r' i
❑ ADDITION. ❑ CHANGE OF USE S z
❑ MIXED USE PARKING L Ij J ii DATE 5
❑ REMODEL 1:1IL
MULTIFAMILY ❑ SIGN REO'D PROVIDED ,�ti
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑
OTHER
Z ❑GARAGERETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
I:=
(TYPE OF USE, BUSINESS OR C^IVITY) EXPLAIN:
OCC P
TYPED S Yj TI �' GROUPANTn
(Y j/ �`
NUMBER UMBER OF
OFDWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REmove/re lace gas water heater REMARKS z
In Utlllty closetGEOTECHREPORT m
BY:
40,000 STRUCTURAL DESIGN
BY:
VALUATION
vW 1
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: PlumbingBase Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
LLE DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g .
SEPARATE PERMISSION,
Engr. Review
W 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 Engr. InSPeC110n
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN 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
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE v
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #jalgi
I HEREBY ACKNOWLEDGE THAT I 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.I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Official or his/her 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 COMPENSATIO RANCE AND RCW 18:27, CI IGN URE ATE .
SIGNATURE ( E O GWNT: DATE SIGNED (425) V
I ) CA Xd n,
X41 A 1 0 -1 9— 0 5 771m0220 RE ASE Al'
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 l IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
O
-'I
m
cM
ma
-� O
Oc
M
mZ
10 EmilZ
r'=
W
Q
ern
O�
nm
t �
N
Z
D
t Z
O
n
M