20170113134903.pdfkITY O�F EDMONDS
1215TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: APPLIED 01/13/2017
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Parcel No: 27041800312300
DAVID & DEBORAH FOURNIER GENE JOHNSON PLUMBING & HEATNG ,GENE JOHNSON PLUMBING & HEATNG
8917 196TH ST SW C/O DENNIS HAMON C/O DENNIS HAMON
EDMONDS, WA 98026-6329 10011 GREENWOOD AVE N 10011 GREENWOOD AVEN
SEATTLE, WA 98133 SEATTLE, WA 98133
(206) 7,16-2220 (206) 789-6610 (206) 789-6610
LICENSE#: GENEJJP924RT._ EXP:O1/11/2019
PRIVATE WATER SERVICE REPAIR
VALUATION: $0.00
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION 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.
UPS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,
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Kurz o�01`
Signature ` Print Name Date` Released Icy " Date
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF<
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCl O/ IRCI 10,.
ONLINE APPLICANT ASSESSOR OTIIER U�
STATUS: APPLIED_ BLD
• 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' City inspections including' final project approval and final
occupancy inspections.
Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specifically 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-refundable.
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• Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has 'not been
specifically identified, requested and considered by the appropriate` city official in accordance with the appropriate provision'
of city code or state law does not approve any items not to code specification.
+� Sound/Noise originating from temporary construction sites as a result of construction activity are exempt .from the noise limits
of Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays,` excluding
Sundays and Federal Holidays. At all other times 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 ininterests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this pernut.Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance
provision;
INS I) U17TIONS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK S TO BE DONE ON PRIVATE
ATE PROPERTY. ONLY. ANY CONSTRUC ON ON
TI O E
PUBLIC DOMAIN (CURBS,' SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
n calling for an inspection please leave the following infc
re es fed'„ Contact Name and Phone Number Date
•. E-Water Service Line
of Number, Job Site Address, Type of Inspec
Iwhether Lou'ptefer,moraing or afternoon.
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DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
p
PERMIT APPLICATION
I.
121 5`h Avenue N, Edmonds, WA 98020
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Phone 425.771.0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: Phone: Fax:
6T&L 106&1k~_ 764-7"- 6"_ JMP-73SY
Address (Street, `ityw Stale., Zip'): E all Address.
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PRI;II"I`" f)WNER: Phone: Q
zsa'j 62V 1r Al '
Address (Street, City, ate, e?lp): � �. � E-Mail Address:
P
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip)„ E-Mail Address:
CONTRACTOR:* Phone: =_�j Fax:
�sNt �O�Swv � v�n�rt
Address (Street, City, State, Zip); E-Mail Address:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
PLUMBING MECHANICAL TANK DEMOLITION
� ��. ....:........ _ I
FDETAILTHE SCOPE OF WORK: ��y", : _,. �a++t,_. ^ � �,,,� _. __ . -. ..
I declare under penalty of perjury laws 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 application to the City of
Edmonds.
Print Name; �.r`'�`..�......,� n'f Vim✓ ,,,,,,,,,,, ,,, Owner ElAgent/Other (specify): �U I.
w....._.....
Signature: _. P_— Date: . 1 .T 1 a*7. ......._.���.
FORM C LABuilding New Folder 2010UDONE & x-ferred to L-Building-New drive\Form C 2014.doex Updated: 1/17/2014
Fixture Type (new and relocated)
Total #
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Pressure Reduction Valve/Pressure Regulator
_......
Sink (kitchen, laundry, lavatory, bar, eye wash, etc)
_ 6
.......
Water Service Line
.... .........._._i_..........
w
Tub/ShOwer......-..._.....A
Drinking Fountain
Dishwasher __ _.........
Clothes Washer
Hose........._._._._ ............. -
Bib
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes ❑ No ❑
Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #_Elec
#_Other:
—
#___ BTUs: <100km,— >100k
Location(s), ..__mmmmmmmmmmmmmmm,
Air Handler / VAV
Gas #_Elec
#_Other:
#, <10k— >10k..._._._
Location(s), _`
(circle selected)
,_µµ
�CFM:
AC / Compressor /
Boiler / Heat Pump /
Gas #_Elec
#_
Other: ......... ._._
# BTUs:. ............. _<100k,
100k-500k, 500k-Mil
Roof Top Unit
HP:
<3,..........-..............
3-15.............................. 15-30
Location(s) _.................._
(circle selected)
Hydronic Heating
Gas #_Elec
#_In
-Floor ,,,Wall Radiant_ Boiler BTUs:
Location .,.,-,..._ _-IT-.___m.
Exhaust Fans (single
Bath #_Kitchen
#_Laundry #
_Other:,
duct)
Fireplace
Gas #_Elec
#_Other:
... ,,............................
# Location(s) .........._ ,,,
.µ--.._, ...... _�,
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs;.__ ............ Location(s,):,..., ..,....,. ..�....... . „ _
Furnace
BTUs:. Lttcatiotl(sy:— v..._..... _...�........
_.............. �
Water Heater
BTUs: Locatit►tt(.i:,-.._ ...__.. __.........
....
Boiler ...........................
uBTUs:.__..... w . - ..--..... Location(s): ...._ _..........._
Other:
BTUs:_.._ .. . 1.ttctcctn(«)» w.....---.._-........ .....m.
Fireplace/Insert .........
BTUs: P _............. CAtcatlon( ,):_.....-_____- .m ...... ......m..
Stove/Range/Oven
Dryer
-- .....
Outdoor BBQ
TOTAL OUTLETS
FORM C LABuilding New Folder 2010\130NE & x-ferred to L-Building-New drive\Form C 2014.doex Updated: 1/17/2014