20051168.pdfDATE RECEIVED
I
,CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Jones,'Floyd
MAILING ADDRESS
21425 80 Ave 19
CITY ZIP TELEPHONE
E'dirtionds 98026 425-771-4315
NAME
CBL#
Fast Water Heater
ADDRESS
12601 132
Ave N.E
CITY
ZIP
TELEPHONE
Kirkland
98034
425-814-3124
STATE LICENSE NUMBER
EXPIRATION DATE
C�ffiCKED
BY
.FASTWHC052DF
2-16-07
A
PROPERTY TAX ACCOUNT PARCEL NO.
27043000106400
13
NEW
RESIDENTIAL
X I
MECH
A��
ADDITION
COMMERCIAL
COMPLIANCE OR
OF USE
MIXED USE
CHANGE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
El CYDS I X FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
5 1 1 PERMIT EXPIRES
PERMIT
NUMBER L�?60(5-
JOB SUITE/APT#
ADDRESS 21425 30 Ave W
PLAT NAMEISU BDIVI SION NO.
Lib NO,
_17
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approled
1-3
RW Permit Requited
M
Street Use Permit Requited
E3
EXISTING PROPOSED
inspection Required
0
Sidewalk Required
E3
REQUIRED DEDICATiON FT
Underground
13
[3
wiring required
METER S12
REMARKS
OWNERICOf
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FIRE REVIEWED BY
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DATE
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NUMBER
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NUMBER OF
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CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO OE DONE
.Remove./replace gas water heater in]
REMARKS
laundry room 40,000 btu's
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
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.*,
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
#
cZT9771M
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAAOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPEN��NCE AND RCW 18:27.
CALL.
FOR INSPECTION
(425)�
771-0220
_�jReceipt
PPLICATION APPROVAL
This application is not a permit t,ntil signed by the
Building Official or hisihor Deputyi and Fees are paid, and
receipt is acknowledged in space provided.
OFFI SSI 'U D E
SIGNATURE (C M-1 T):
V.
DATE SIGNED
12-26-05
—RELEAsrII31
k� DATE
ATTENTION tzA L I;JJJ
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 if IBC110 if IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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