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20170119111211.pdfCITY 1215TH AVENUE NORTH -EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 Parcel No 27043000207800: 8528 218TH ST SW 8528 218TH ST SW EDMONDS, WA 98026 EDMONDS, WA 98026 (425)776-4167 (425)'776-4167 WATER LINE REPAIR /'SECTION REPLACEMENT NEAR ME VALUATION: $0.00 ammum OWNER EXEMPTION CIO JAMES W & LOIS7 SUTER 8528 218TH ST SW' EDMONDS, WA 98026 (425)776-4167 LICENSE 4: EXP: REQUIRED`,: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED: HEIGHT ALLOWEDO PROPOSED:O JREQUIREDPROPOSED: SETBACK NOTES: 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, T APPLICATION IS NOT PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID, "Sig"nature Print Name Date Released W 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/ IBC110/ IRC110 ONLINE APPLICANT ASSESSOR OTHER 1 , A. DEVELOPMENT SERVICES PLUMBING, MECHANICAL, TANK, & DEMOLITION PERMIT APPLICATION 121 5`h Avenue N, Edmonds, WA 98020 t. 6, Phone 425.771.0220 4 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 APi' LsAN"'I"• 1'ltine: Fax: ;. �7, " ". 1, ( 9 D Address (Street City, State, Zip). -Mail Addr ss' 1) HIIERTY OWNER:. Phone. Fax: TC . the- �- Uj S Lt �., Address (Street, City1ltr, " i ): S.ti .. � Lo E i oia7 L T,lN Aulr s„sl loco 5+. YID "1 LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: CONTRACTOR:* Phone: Fax: 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 DETAIL THE SCOPE OF WORK:.. �. rR-�... 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 i:._.,�m..� f)tsntWr ❑ Agent/Other ❑ (specify)r Sin:1.... �...... Date:. FORM C L:\Building New Folder 201MONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014 PLUMBING Fixture Type (new and relocated) Total # FIXTURE COtJNT Fixture Type (new and relocated) Total # Water Closet (Toilet) Pressure Reduction Valve/Pressure Regulator Sink (kitchen, laundry, lavatory, bar, eye wash etc.) Water Service Line ... Tub/Shower - ........ -........ �� Drinking Fountain Dishwasher Clothes Washer �w.w__ ............... ............._� Hose Bib _... Backflow Prevention Device (e.g. RBPA, DCDA, AVB) Water Heater Tankless? Yes Noo H dronic Heat in: Floor 0 Wall Floor Drain/Floor Sink - ................ Other: -------- Refrigerator water supply (for water/ice dispenser) I Other: Equipment Type Appliance/Equipment Information (new and relocated) Total # Furnace Gas #—Elec # v t?tlat t ...,.. „ # BTUs: <100k_ >100k_ Location(s) _.._._.,., Air Handler / VA V Gas #,,,,.Elec #,,w,.�.Other:.... # CFM: <10k >10k_ Location(s)_ mmmmmmmm (circle selected) AC / Compressor / Boiler / Heat Pump / Gas #_Elec #_Other:-m,m m _ # BTUs:_................_<100k, .._...... _......a00k-500k, 500k-Mil Roof Top Unit HP: <3, 3-15, 15-30 (circle selected) Hydronic Heating Gas #_Elec #In -Floor .........Wall Radiant, ........ Boiler BTUs: Location Exhaust Fans (single Bath # #_Laundry #—Other:_..............-m __ ....._. # ........ duct)..... _________Kitchen Fireplace Gas #_Elec #_Other: # ( Dryer Duct Appliance Type Appliance/Equipment Information (new and relocated) Total # AC Unit BTUs: a.--. Location(s):_,,, Furnace BTUs: .... _.. Location(s):_.�.�.....W .. ..........._. Water Heater Wv_ ... BTUs:....._. ...._._._... Location(s):—. ..... Boiler BTUs:..... ,,,........ Location(s): ......m ------ Other: ..... ........ BTUs:._..... Location(s):........ Fireplace/Insert BTUs: _ Location(s):..� Stove/Range/Oven Dryer Outdoor BBQ TOTAL OUTLETS FORMC L:\Building New Folder 2010\DONE & x-£erred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014 EXEMPTION FROM CONTRACTOR REGISTRATION VERIFICATION FORM D The undersigned property owner or authorized person as described below, has applied for a building permit from the City of Edmonds and claims that he/she/it is exempt from providing contractor registration in accordance with the provisions of RCW 18.27. The property owner or authorized person, by their signature below, hereby verifies to the City of Edmonds that: ❑ Value of work under $500.00. The aggregate contract price of labor and materials and all other items required for the project is less than $500.00 and is not part of a larger operation to be undertaken on the property. This exemption does not apply to a person who advertises or puts out any sign or card or other device which might indicate to the public that he/she is a contractor, or that he/she is qualified to engage in the business of contractor. RCW 18.27.090(9). ❑ Owner who contracts for a project. A property owner contracting with registered contractors for the project, and who him/herself is not performing any activity of a contractor for the purpose of leasing or selling improved property that he/she has owned for less than twelve months. RCW 18.27.090(11). ❑ Work performed personally on own property. Anyone personally working on property he/she owns, or at which he/she resides, as long as the property owner, or resident, does not perform any activity of a contractor on his/her property for the purpose of selling, demolishing, or leasing the property. RCW 18.27.090(12). ❑ Use of own employees. Property owner using him/herself or his/her own employees to perform maintenance, repair, and I alteration work in or upon his/her own property. RCW 18.27.090(13), Licensed Architect, engineer, electrician or plumber. All wore Ferfonncd under this perinit will be perl"or ned by an architect, civil or professional engineer, certified electriciala or certified plumber operating within the scope of fri flier certification. RCW 18.72.090(1 ). ❑ Other. Specify which provision of RCW I i.27.090 applies: THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED. DATED this lot day of , 20L 1. PROPERTY OWNER/AUTHORIZED PERSO ,r S i ature Print Name WITNES""" Signature —Y vis�i Priam Name L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM D.DOCREVISED 7/07