20051084.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Allyn, David
MAILING ADDRESS
9627 242 Fil SW
CITY ZIP TELEPHONE
Edmonds 98020 1206-542-2255
NAME
ADDRESS
NAME
F'ast Water Heater
ADDRESS
12601 132 Ave NE
CITY Kirkland ZIP TELEPHONE
Edmonds 98034 1499;-R
STATE LICENSE NUMBER I EXPIRATION
FASTWHCO52DF 2-1*6-07
PROPERTY TAX ACCOUNT PARCEL NO.
00450300000102
0
2-9 1 [6 1PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
9A?7 94?nrl P1 9W
SUITEIAPT#
119
PLAT NAME/SUBDIVISION NO.
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved 0
E3
RW Permit Required
Street Use Permit Required E3
EXISTING PROPOSED
Inspection Required 13
Sidewalk Required C1
REQUIRED DEDICATION FT
Underground E3
...... .. . d 13
METER SIZE
N�
NO. OF FIXTURES
PRV REQUIRED
YES13 NOM
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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WAIVER 13
STUDY 13
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COMPLIANCE OR
USE
MIXED USE
CHANGE OF
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SIGN
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REO'D
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GRADING
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TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY).rXPLAIN:,
7VLEWED BY 0 - DATE
A expansion tank shall be
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ALLOWED I PROPOSED ALLOWED ROPOSED
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EQUIRED SETBACKS (FT.) PROPOS D SETBACKS (FT.)
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CODE
05
OCCUPANT
GROUP
1 IR3
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION [CONSULTANT
REQUIRED 13 YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
Remove/replace ctas water heater
REMARKS
in laundry room 30,000 btu's
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
ATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
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, HEIRS, 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. -
uv' 'u".'
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
TotalAmt. Due
Recording Fee
Receipt #
R MAT'ON
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI ON; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
S T
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
M P Y
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)
77100220
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
OFFIJ OA DATE
SIGNATURE (OWNER 0 GENT
DATE SIGNED
5
11 - 2 30]
DATE
ATTENTION XT. 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 / IBC110 / IRC110. PINK - OWNER GOLD - ASSESSOR
110/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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