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DATE RECEIVED
CITY OF EDMONDS z
CONSTRUCTION PERMIT APPLICATION i
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MAILING ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY W. ACCOUNT PARCEL NO.
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NEW RESIDENTIAL PLUMBING I MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS ( X Fr)
DEMOLISH TANK El OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSIN5ES� A I IN. EXPLAIN,
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NUMBER
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STORIES
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GLAZING %
LOT SLOPE %
ECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR Limi r IN ANY WAY THE CITYS ABILITY FO ENFORCE ANY ORDINANCE 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 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
,�IGNATURE (OW OR A6�"e
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PLAT NAME/SUBDIVISION NO. LOT NO.
IUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRE[) DEDICAIION_ FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
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SUITE/APT#
LID NO�
LID FEE $
TESCIP Approved
RW Permit Required
Street Use Perine Aoq'd
Inspection Required
Sidowalk Required
Underground
Winng required
PRV REQUIRED
YES13 NO 13
IEMARKS
)WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
INGINEERING REVIEWED BY
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IROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ1D I �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description FEE
State Surcharge
City Surcharge 15
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Base Fee
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(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
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.
FF)CIALVaIGNATURE // IATE /
ATTENTION E)ff 1333 v
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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PINK - OWNER GOLD - ASSESSOR
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Jun 2!5 04 04:46p P. 3
BUDGET TANK REMOVAL & ENVIRONMENTAL
SERVICES., LLC
P.O. Box 77552
Seattle., WA 98177-0552
206-306-9061 Fax: 206-306-9091
Contractors License No. BUDGETR973CL
TRIPLE RINS CERTIFICATE
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BUDGET TANK REMOVAL & ENVIRONMENTAL
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SERVICES LLC, certifies that on June 24� 2004, th e tank
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located at: 608 2 Ave N. Edmonds, WA, was pumpe
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Signed:
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F1-iedmnm&Bruys 06/ZS/04 10%36am 002
Date of Report: 06/25/04
Date Received: 06/24104
Project: BES 0341
Date Extracted'. 06/24/04
Date Analyzed: 06124/04
RESULTS FROM THE ANALYSIS OF THE SOIL SAMPLE
FOR TOTAL, PETR oLEum HYDROCARBONS AS DIESEL
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USING METHOD NWrPH-Dx
Extended to Include Motor Oil Raxkge Compounds
Results Reported on a Dry Weight Basis
Results Reported as g9/9 (PPM)
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BUDGET TANK REMOVAL &ENVIRONMENTAL
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SERVICES9 LLC
P.O. Box 77552
Seattle, WA 98177-0552
206-306-9061 Fax: 206-306-9091
Contractors License No. BUDGETR973CL
DEC MMISSIONING CE-R-1-101-C—A—Th
OIL TANK 0
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OIL STORAGE TAN K AT: 608 2 Ave -N
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This is to C ertify that BUDGET TANK REMOVAL &
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ENVIRONMENTAL SERVICES9 LLC, decoirmiissioned one
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Matthew P. Veeder - Project Coordinator
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P.O. Box 77552
Seattle, WA 98177-0552
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS .......... ---
FINAL APPROVAL-FQB
-eeCUPATTCY ..................
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