1323_001.pdfCITY OF EDMONDS
12I 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (AÐ77rA20 - FAX: (42Ð771-0221,rc, I
STATUS: ISSIIED 06/0512019
Expiration Date: 12105 /2019
Parcel No: 00766100000500
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BI]II,DTN(; PEIIMIT
\PPLIC ANT C]ONTIìAC]'ORI'IIOI'ERTì'OWNER
VIJAY VISHESH & PRAGYA UPRETI
I I2I OLYMPIC AVE
EDMONDS, WA 98020-2514
MELANIE BURNDA
5720 22OTH ST SW #B
MT LK TERRACE, WA 98043
(206) 409-5s3s
PAC WEST PIPELINE LLC
C/O CALEB NCrO
2301I I25THAVESE
KENT" WA 98031
(206) 349-02s1
LICENSE #: PACWEWPSI IKA EXP 05/0112021
.f oB DF.SCR.IPlìON
HWT
VALUATION: S0
PERMIT GROUP:47 - PlumbinePERMIT TYPE: Residential
GRADINC} N CYDS: O TYPE OF CONSTRUCTION:
OCCUPANT GROUPRETAINING WALL ROCKERY:
OCCUPANT LOAD:
CODEFENCE: ( 0X0 FT.)
ZONEOTHER: ------ OTHERDESC:
VESTED DATE:NUMBER OF STORIES: O
2ND FLOOR: 0IST FLOOR:0
LOT #
BASEMENT:O
NUMBER OF DWELLINGUNITS: O
2ND FLOOR: 0BASEMENT:O lST FLOOR: 0
3RDFLOOR:0 GARAGE:0 DECK:0 OTHER:03RD FLOOR:0 GARAGE:0 DECK:0 OTHER:0
BEDROOMS:0 BATHROOMS:0BEDROOMS:0 BATHROOMS:0
l)ll.() l'O s lil) ¡\l{l:Âlxts'llN(; \nlì\
REOUIRßD: PROPOSED:REQUIRED: PROPOSED lRr,eurnnp: PRoPoSED:
HEIGHT ALLOWED:O PROPOSED:0 lRneunro: PRoPoSED:
SETBACK NOTES:
IÌE,AR SIiI'BA(-KSIDESETBA(,hFRONï'SETIìACh
I AGREE TO COMPLY WTH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZ ÉD THEREBY, NO
FERSON WLL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE-ATING TO WORKMEN'S COMPENSATION
INSURANCEAND RCW I 8:27.
THIS APPLICATION IS NOTA FERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL ALL FEES ARE PAID.
PERMIT APPROVAL
7
Nanæ Date By Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTON HAS BEEN MADE AND APPROVAL ORA CERTTFICAÏE OF
OCCUPANCY HAS BEEN GRANTED.UBC109/IBCI IO/ IRCI IO.
FIRE APPLICANT ASSNSOR CITY
CONDITIONS
STATUS: ISSUED 8LD20190657
In addition to the required pressure/reliefvalve, an approved listed eryansion tank shall be installed on all hot watertanks. per
UPC 608.
Cas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check the job card for all required Cify inspections including final project approval and final
occupancy inspections.
Any request for altemate design, modifìcation, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specificalþ requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refl¡ndable.
Approval of any plat or plan containing provisions which do not compþ with city code and forwhich a variance has not been
specificalþ identified, requested and considered by the appropriate cþ offìcial in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
Sound/lrloise originating fromtemporary construction sites as a result of construction activity are exempt fiom the noise limits
of ECC Chapter 5.30 onþ during the hours of 7:00amto 6:00pm on weekdays and l0:00am and 6:00pm on Saturdays, e>rcluding
Sundays and Federal Holidays. At all othertimes the noise originating from construction sites/activities must comply with the
noise limits of chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
Applicant, on -behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemni! defend and hold
harnrless the City of Edmonds, Washington, its ofücials, employees, and agents from any and all claims for damages of
whatever nature, arising directþ or indirectþ fiom the issuance for this permit. Issuance ofthis pemit shall not be deemed to
nrodif,, waive or reduce any requirements of any Cþ ordinance nor limit in any way the City's abilify to enforce any ordinance
provision.
Installation, use and nmintenance of equipment and components shall be per manufacturer's specifications, installation
instructions, and applicable state codes. Provide manufacture's installation instructions on site for Building Inspector.
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INSPE('TIONS
THIS PERMN-AUTHORZES ONLY THEWORK NOTED. THIS FERMT COVERS WORK TO BEDONEON FRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDH/VALKS, DRMM/AYS, MARQUEES, ETC.) WLL REQUIRE SEPARATE FERMISSIoN. PERMIT
TIME LlMlf: SEE ECDC r 9.00.005(A)(6)
TO SCHEDTJLE INS PTTTIONS
BUILDING ENGINEERING (425) 771-0220 EXT. 1326
1. Go to: www.edmondswa.gov
2. Then: Senices
3. Then: Permits/Delelopment
4. Then: Online Permit lnfo
5: lf you don't hare one already, create a
login (upper right hand corner)
6: Schedule your inspection
Building Department lnspections
are now scheduled online. lf you
haw diffculties, please call the
Building Department front desk for
assistance during ofice hours.
(425) 771-0220
F|RE (425) 775-7720
PUBLIC WORKS (4251 77 1 -0235
REGYCLT NG (4251 27 54801
When calling for an inspection please I eare the following information: Permit Number, Job site Address, Type of lnspection
bei Contact Name and Phone Number Date Prefered and wfiether or afrernoon.
a
BCas Test/Pipe
B-Plumbing Final
rlc. l8
BUITDING PERMIT
APPLICATION
Development Services
Building Division
121 sth Ave N / Edmonds, WA 98020
42s.771.0220
For handouts, submittal requirements, perm¡t status and inspection
schedu ling information go to: W\,v.edn[en_d$Ue.ggv.
PLEASE NOTE: lntake appointments are required for New Single Family
Residences, Lorge Additions, ADU's, New Commercial, and Major fenanl.
lmprovement application submittals. lf plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Piease cøll 425-771-0220 to schedule an íntdke øppointment!
Permit #:
n AccessoryStructure/
Detached Garage
! Addition
! Mechanicaln Demolition
n New Single Family / Duplex {etumbing
! Remodel! Fire Sprinkler
JOB SITE ¡NFORMATIO the work is place)! New Commercial/ Mixed Use ! Re-Roof
Job Site Address
Parcel:
th JL ! Signs n Tank
! Tenant lmprovement ¡ Other
Lot /Unit/Suite f : _ Subdivision
PROPERTY
e+¡
Remodel Permil fees ore bosed on:
The vqlue of the work performed. lndicote the volue (rounded to
the neoresf dollor) of oll equipment, mqleriols, lobor, overheod,
ond fhe profil for the work indicoled on this opplicotion.
I
I
,
Name:
Mailing Address
Voluolion:
city/state/zip:0
Phone #:
Email:Basement sq ft:Finished tr Unfinished !
OWNER INSTAILATION: *lf yes, read and sign*
Will work be performed by the property owner? ü Yes 6 1st Floor, sq ft:
I own, reside in, or will reside in the completed structure. This
installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange according to RCW
2nd Floor, sq ft:
Garage/Carport:, sq ft
18.27.090.
Owner Signature
Deck/Covered Porch/Patio:
APPTICANT/ CONTACT
(U5 LLC
Other sq ft:
Name of Applicant:
Mailing Address:2
City/State/Zi
Phone #:5
E-mail eÁ¡4
GENERAL CONTRACTOR: (lf different from applicant)
General Contractor:
Mailing Address:
city/state/zip
Phone #:
E-mail:
I certify that the information I have provided on this form/application is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner to submit a permit appl¡cation to the City of
STATE UBI #:
Ed
CITY OF EDMONDS BUSINESS t¡CENSE -/Name
r(f)(,.vl
WA STATE CONTRACTOR t & I #: (CCB) & EXPIRATION DATE:
Signature:
z ?
Date "t I
TYPE OF PERMIT (Provide Deloils on Poge 2)
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
PROJECT DESCRIPTION
Occupancy Group(s)Occupant Load(s)
Type(s) of Construction Fire Sprinklers: Yes E No !
WA STATE ENERGY CODE: lf your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
Tl / CHANGE OF USE / NEW BLDG: lnclude TRAFFTC tMpACT worksheet
BTUS Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
Qtv Qtv
Clothes Washer Tub/ Showers
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain Pressure Reduc-tion/ Regu lator Valve
Floor Drain/Sink Refrigerator Water Supply
Hose Bibs Water Heater - Tankless? Y or N
Hydronic Heat Water Service Line
Sinks Other:
Toilets Other:
GENERAL COMMERCIAL DATA
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
PLUMBING FIXTURE COUNTS (New, Relocated or re-piped)
BTUS Qty BTUS Qty
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Ra nge/Ove n
Dryer Water Heater
Fireplace/ lnsert Other:
Furnace Other:
Qtv Qtv
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medlcal - Surgical Vacuum Other:
Type of structure to be demolished
Square footage of structure to be demolished
AHERA Surveydone? Y/N PSCAA Case f:
Critical Areas Determination:
Study Required E Conditional Waiver E Waiver E
Fill in Place E Fill Material:
Removal n Size of Tank (Gallons)
Critícal Areas Determination:
Study Required E Conditional Waiver E Waiver E
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes E No E
APPLICATIONS: Applications are valid for a maximum of 1 year
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & lndustries and have a
current City of Edmonds Business License.
GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re-piped)
DEMOLITION
TANK
G RADE/FrLL/EXCAVATE
GENERAL PROVISIONS