910135.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
DONALD L. HENDERSON
w MAILING ADDRESS
15825 - 75th Placer W.
O
CITY ZIP TELEPHONE NUMBER
Edmonds 98020 1 745-1540
CITY ZIP ITELEPHONE NUMBER
NAME RELIABLE SHEET METAL/DBA
ARCO INSTALLATIONS
ADDRESS
3810 196th St. S.W. #8
CITY ZIP TELEPHONE NUMBER
Lynnwood 98036 670-1256
STATE LICENSE NUMBER
ARCOIL*141LE
Legal Description of Property - include all easements
(show below or attach two copies)
J
a
Tax Account Parcel No.
" NEW LJ RESIDENTIAL
® ADD/ALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE, FILL
DEMOLISH OR GRADE _
CARPORT
REMODEL GARAGE
�j WOOD STOVE/ ❑ RETAINING WALL/
L� INSERT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
LJ PLUMBING
® MECHANICAL
n
LJ SIGN
FENCE
( x _FT)
rl SWIM
ElRENEWAL
USE PERMIT
ZONE NUMBER
SUITE/APT h
AESS 15825 75th Place W. r Edmonds
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
TESCP
APPROVED BY
METER SIZE (BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE OR CU
SETBACKS - FEET
FRONT SIDE
CHECKED BY
REAR
REVIEW BY
ADB NO.
SHORELINE N
GATE
HEIGHT I LOT COVERAGE
HEIGHT
[REMARKS
PECIAL INSPECTOR AREA OCCUPANCYOCCUPANT
EQUIRED GROUP _ LOAD
❑ YES U: NO
ROGRESS INSPECTIONS PER UBC 305
NUMBER OF STORIES NUMBER OF
2/W. Basement DWELLING 1
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
INSTALL GAS FURNACE, HOT WATER TAN FINAL INSPECTION REQUIRED
IN BASEMENT VALUATION
PLAN CHECK FEE
100 000 BTU Furn. 80 ft. Pl In i BUILDING
3 Outlets) PLUMBING
Plan Check NO. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
u) successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
5 employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly ATTENTION
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED
tion Insurance. INSPECTION
SIGNATURE (OWNE OR AGENT) DATE/SIGNED DEPARTMENT
�� i 6 cL �L-u :_. �/ I ? �✓/ CITY OF
EDMONDS
ALL FOR
ATTENTION IN PECTIION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102.67
15.00
5.00
M6 0 0
:- 1137
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICI&S SIGNATURE DATE
RELEASED BY:
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ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor
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to
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ON
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ... . .
i
� `FOUNDATION: •
Footing' .........:.
Wall.....
Pier/Porch .............
Retaining Wall. L L
PLUMBING: _
Underground
Rough -In ..............
CF '
f . HEATING:
Gas Test. .
Gas Piping
IL Equipment ...1 0 .. .
CF ... ..
FRAMING .
SHEETROCK NAILING ... .
SPECIAL INSPECTION
�1C..
FINAL APPROVAL, wo
FOR OCCUPANCY
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