20040668.pdfI
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PERMIT EXPIRES
DATE REC
USE PERMIT
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CITY OF EDMONDS NUMBER �14
JOB
CONSTRUCTION PERMIT APPLICATION sUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
cc MAILING7AD6RESS LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 11
Street Use Permit Roq*d 13
441 ad E3
0 C9 inspection Roquir
CITY ZIP ELEPHONE EXISTING - PROPOSED Sidewalk Required 13
REQUIRED DEDICATION� FT Undergroiind
Wiring coquired [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2 Engr. Review
cc PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt H
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECRY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMIT SHAIA NOT 13E Landscapelnsp. Total Amt. Due
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
xi — Recording ee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, onTfIE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC I his application is not a permit until signed by the
TION; AND IN DOING THE WORt( AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy and Fees are paid, and
IN VIOLATION OF TIiE#R'MgDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
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WORKMEN'S COM I N INS I(IANCE A�p RCW 16.27. OFFICIAL� SIGN TURE DATF
SOIGNAT ATE SIGNED (425)
771-0220 Hri rASFd BY DATE
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ATTONTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGINAL FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/]RC110. PINK . owNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
LETTER OF CERTIFICATION ProTank-USA, Inc. Job #3527
August 10, 2004
Amy Vaughn
8025 Sierra Dr.
Edmonds, WA 98026
To: Amy Vaughn
ProTank-USA, Inc. certifies we decommissioned one residential heating oil tank located
at 8025 Sierra Dr., Edmonds, WA on August 10th, 2004. The method of
decommissioning was pumping the contents of the tank, rinsing, and filling the tank with
polyurethane foam.
Decommissioning was in accordance with the Uniform Fire Code of the State of
Washington and the local Fire Marshal's guidelines.
The contents of the tank were disposed of at Emerald Petroleum Services, Inc. located at
1500 Airport Way South, Seattle, WA.
The decommissioning was conducted by Mark Horsch.
Sincerely,
Mark B. Horsch, President
International Code Council Certified Decommissioner #1 131625-U2
ProTank-USA, Inc.
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RECEIVED
12 2004
SE-FiVICES CTR-
r
�;Ilv OF EDMONDS
FINAL PROJECT APPROVAL FORM
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE4!W--T---
FROM:
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
C_7�11
PROJECT
SITE ADDRESS_f�
PERMIT ADB# DATE INSPECTED
d
DESCRIPTION OF WORK TO BE INSPECTED
A field insp . ection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
TO:.'O/—�2
D A T E:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbmis:ocaprv1 3/25/04
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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:
GasTest ....................
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 P911010'
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