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PERMI EXPIRES
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Description
FEE Description FEE
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Plan Check
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PLAN CHECK NO'
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THIS PERMIT AUTHORMES ONLY THEWORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
2- DOMAIN (CUR5S. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
I. PERMIT APPLICATION: SEE ECDC I9,0s0D5(A)(5t
Eng, RaV,ew
Recording Fee
PERMIT LIMIT SEE ECDC 19.00.005(AI(6)
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
En9r. Inspection
717 Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, AS SIGNS AND SUCCESSOR
Receipt #
IN NTEREBE AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLES S THE CITY OF
Fire ReVieW
EDMONDS, WASHIN N, OFFICIALS, EMPLDYeES, AND AGENTS FROM ANY AND
NATURE, ARISING DIRECTLY OR INUIR
T.Zl AGRI Due
LLCLAI SFORDAMAGESO F WHATEVER
FROM THE ISSUANCE .1 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOECTLYE
Fire Inspection
SEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Receipt 4
No R LIMIT IN ANY WAY THIS CITY�S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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APPLICATION APPROVAL
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THERE Y ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION; THAT THE INFORMATION
HE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND E LAWS REGULATING
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FOR INSPECTION
TIoN; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYE.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIO II,ISURAN�1AN.FCWI&11.
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OFFICIALS SIGNATURE UAI.
_�_IGNATURE jOWNER 0 DATE SIGNED
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110,
PINK � OWNER - GOLD - ASSESSOR
61os PRESS HARD - YOU ARE MAKING 4 COPIES
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05/07/2007 14!41 FAX 4257412500 NITROX INC 002
Medical Cases Medical C05 Line VerifjCoticris Ana*SiO Equ'Pmenr
mitroxinc.
DFN'TAL AIR AND VACUUM VERIFICATION
4 MAY 2007
CONTRACTOR: Dr YONG
TIME OF TESTING: 23 APRIL 2007 1:15 P
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DATE AN
S.
FACILITY: Dr. YONG, D.D
21911 — 76 Ave. W,
EDMONDS, WA.
AL AIR AND VACUUM SYSTEMS
SCOPE OF WORK: NEW DENT
GENERAL FINDINGS: p
_E IN COMPLIANCE WITH NFPA 99
A DENTAL AIR AND VACUUM A
(2005ed�) LEVEL 3, DENTAL
FOUND IN DENTAL AIR OR VACUUM
B. NO CROSSED LINES WERE 'AY OF TESTING.
IN TESTED AREAS ON TIM D
4EETS OXYGEN CONCENTRATION
C. DENTAL AIR N PRESSURE REQUIREMENTS.
D. DENTAL AIR mEETS FLOW AND LEVF
L AND FLOW
ACUUM
E. DENTAL VACUUM, MEETS V
REQUIREMENTS,
,YSTEM COMPONENTS IN ARE
F. DENTAL AIR AND VACUUM �� LEVEL #3
ARE IN COMPLIANCE WITH NFPA 99 (2005ed-)-
24 HOURS: PASS
RE TEST FOR
G. LINE PRESSU CITY OF EDMONDS: 4 BLD2006-0419
OTIJER AUTHORITY'
DENTAL AIR:
A. STATIC LINE PRESSURE: 95 PSIG.
B. CONCENTRATION OF OXYGEN: 20.8
DENTAL VACUUM* uugv.
A. STATIC DENTAL LINE VACUUM
PARTICULATE LINE TEST: PASS.
IV. SERVICES CTR.
V. ODOR: NONE CITY EDmOND
yoNG-04.23.07
2706 164th Street S.W., Lynnwood, WA. 98087
(425)741.8807 - 1,800,736-7047 - Fax:(425)741-2500
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05/67/2007 14:41 FAX 4257412500 NITROX INC 16003
AWANL Analgesia Equil`m"r
trox Inc. Medical Cases Medical Gas Line Verif;WiOns
V1. D ENTAL EQUIPMFNT�
AIR: DUPLEX 1.5 H.P.
A. DENTAL
1. SYSTEM AIR COMPONENTS: PASS
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3. VENTED:
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BRAZIER: TOM
VIL PLUMBING CONTRACTOR: DEBOLD
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V111. WITNESS: Dr. YONG
IX, C01,4MENTS: NONE
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B. AN Mc ALLISTER CRTT, CMGV
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yoNG-04.23.07
2706 164th Street S.K. Lynnwood� WA, 98087
Fm (425) 741 -2500
(425) 741-8807 1-800,7 36-7047
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE 14ORTH EDMONDS, WA 98020 (4251771-0220 FAX (425) 771 M21
Websiw �aedrnonft.wa.US
DEVELOPMENT SERVICES DEPARTMENT
91) Planning - Building Engineering
April 3, 2007
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TO: Dr. Jane H. Yong D.D.S.
7631212"' Street SW Suite 200
Edmonds, WA 98020
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RE: Third Party Testing on Medical Vacuum and Air System
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Permit 2006-0419
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It has come to the City of Edmond's attention that a third party inspection report
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for your medical vacuum and air system was not received prior to your final occupancy
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inspection. Our records indicate that Evan McAllister from Nitrox was to av
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performed the required third part inspection. Please contact Evan McAllister at 425-741-
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8807, to set up a third party inspection. Please provide the report to the City Building
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Division immediately.
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Sincerely,
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Michael Snook
Senior Combination Building Inspector
[ncorporated August 11, 1890
Sister City - Hekinan, Japan
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
ORDER TO CORRECT VIOLATION
'V lation (Address and Tax Account Parcel No): 7631 212th Street SW, Suite 200,
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,0WAI098026 Tax Account Parcel No. 00545500100200
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Issued To: Dr. Jane Y. Yong, DDS, Business Owner
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Address Of Person This Order Is Issued To: 7631212"' Street SW, Suite 200 Edmonds, WA 98026
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Code Section Violated: Uniform Plumbing Code 133 l..O Testing (as amended by the State Buildin
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Code Council)
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Description of Violation Pursuant to UPC 1331.0 third party inspection is required of the medical
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vacuum and air system installed at your place of business. Refer to City letter dated April 3, 2907.
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Corrective Action Required: Contact Special Inspector Evan McAllister from Nitrox at 425-741-8807
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sc e ue r e rNu nspec on. r. c s er w Rrov e nspec on resu s o 14 n a
timely manner.
Correction is Required no later than: 5:00I)m Atim April 16,2007 (date)
If correction is not made by the date and time specified in the Order, a Notice of
Civil Violation shall be issued. The Notice of Civil Violation shall assess fines of
$100.00 per day, or portion of a day, during which the violation continues.
Date Posted: Date Mailed: April 9, 2007 Date Served
Issuing Part - Jeannine L. Graf Title. Building Official
Signature
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
(425) 771-0220
ORDER TO CORRECT VIOLATION
Location of Vio lation (Address and Tax Account Parcel No)� 7631 212'h Street SW, Suite 200,
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Edmonds, WA 98026 Tax Account Parcel No. 00545500100200
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Issued To: Dr. Jane Y. Yong, DDS, Business Owner
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Address Of Person This Order Is Issued To: 7631 212'h Street SW, Suite 200 Edmonds, WA 98026
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Code Section Violated: Uniform Plumbing Code 133 1.0 Testing (as amended by the State Buildin
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Code Council)
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Description of Violatio
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vacuum and air system installed at your place of business., Refer to City letter dated April 3, 2007.
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Corrective Action Required: Contact Special Inspector Evan McAllister ftorn Nitrox,at 425-741-8807
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to schedule for the required inspection. Mr. McAllister will provide inspection results to the City in
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timely manner.
Correction is Required no later than: 5:00pm (time) April 16, 2kO_7(date)
If correction is not made by the date and time specified in the Order, a Notice of
Civil Violation shall be issued. The Notice of Civil Violation shall assess fines of
$100.00 per day, or portion of a day, during which the violation continues.
Date Posted: Date Mailed: ARn
�l 9� 2007 Date Served
Issuing Party Jeannine L, Graf Title Building Official
Signature
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om,*,% Permit Inspection Details
Permit: BLD20060419
PERMITTR4,x
05117/2006 Snook APPROVED
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Total Time: 30
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05104/2006 Snook 30 APPROVED
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Total Time: 30
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1010612006 Snook 20 APPROVED
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Total Time: 20
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Total Inspections:
3 Total Time: 80
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Page I of I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall .....................
Pier/Porch ............ z
Retaining Wall ...........
Stab Insulation ..........
PLUMBING: :4
Underground ............. 0 M
2:
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Rough -In ................... M
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Commercial Final C
HEATING: 3: M
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Gas Test ...............
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4--d . ...............
Gas Piping ...........
Equipment ................. 0 -n
Commercial Final
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EXTERIOR SHEATHING 0—)
NAILING .......................... 0
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FRAMING ........................ C CA
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FIRST FLOOR FRAMING... z
INSULATION ................... ;a
Floor Insulation
Wall Insulation ...........
Ceiling Insulation 0)
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SHEETROCK NAILING
SPECIAL INSPECTION 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................