20170124095436.pdfATTENTION
ITIS UNLAWFUL TO USE OROCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF `
OCCUPANCY HAS BEEN GRANTED.UBC109/ IBCI10/ IRC110.
ONLINE APPLICANT, ASSESSOR 6ZOTHM
STATUS: ISSUED BLD20170109
• Pursuant to UPC 605.2 a,water service shutoff shall "be installed on the water line as it enters the building.
• City approved plastic piping may be used in water service piping provided that where metal water service piping is used for
electrical grounding purposes, replacement piping shall be of like materials (UPC604.8). A state electrical permit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of Labor &
Industries Electrical Division at 425-290-1309.'
• Final approval on a projector final occupancy approval must be granted by the Building Official priorto 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.
•
• 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 fromthe noise limits
of ECC 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 othertimes the noise originating from construction sites/activities must comply with the
noise limits of Chapter5.30,' unless avariance has been granted pursuant tolC. "5.30.120.
Applicant, on behalf ofhis or her spouse, heirs, assigns, and successors in interests, 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 permit. 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.
• Owner/Contractor to provide Water Service Line as built at final inspection. See City Standards for requirements..
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,
• E-Water Service Line
1 EfY
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
# 121 51h Avenue N, Edmonds, WA 98020
s�• 1 ct Phone 425.771.0220 A 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: � /j ( e S 1. 1 LA Y" 61 V - Phone: Fax;;
j Y l
Address (Street, City, State, Zips). E-Mail Address:
PROPERTY OWNER: lw<lx Phone:
Address (Street, City, State, Zip): _ E-Mail Address:
74 2 I y ti ..,. S
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E-Mail Address:
CONTRACTOR:* 1 (r� QI J f Phone: Fax:
Address (Street, City, State, Zip): E-Mail Address:
WA Late License 0113xp, Date:
*Contractor'nust have a valid City of Edmonds business license prior to doing work tM l VQ- 5 P�_ f 1 D 1,M
in the City. Contact the City Clerk's Office at 425.775.2525 CiC Business License #/Exp. Date:
PLUMBING MECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK � !eC ('1 e'. I C _ .. 1� ..... (✓1� � ^ :._
-t->~ y---,-�korvve ri`
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: Owner [ Agent/Other ❑ (specify):
Signature:., Date: ..! /
FORM C L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014
50✓.,
PLUMBING FIXTURE COUNT
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.) Water Service Line I
Tub/Shower�.� ......�,___—.......�,m_
Drinking Fountain
DishwasherV ..�...n._ -_.�...e. ...�,. ., �-wwn.�..
Clothes Washer
Hose Bib .. ...._.....................�...-� r�....�-a____... _ _ ..__....... www.
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes ❑ No ❑ Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink Other:
water
Refrigerator
g ter Supply (for water/ice dispenser) Other:
Equipment Type Appliance/Equipment Information (new and relocated) Total #
Furnace 1 Gas #_Elec #_Other: #_ BTUs: <100k_ >100k_ Location(s)_w..,, — __-
Air Handler / VAV
Gas # Elec #_Other: #_CFM: <10k_ >10k Location(s)___ _ ,,_e .,.m_
(circle selected)
AC / Compressor /
Boiler / Heat Pump /
Gas #_Elec # Other: .... ....... ._..................... _................. #1..................... BTUs: _................................. <100k,_............................. _.100k-500k,....................... ........... 500k-1Mil
Roof Top Unit
HP: .........................<3, ._......................._3-15,........................... Location(s) ... _. . �_........... �.
(circle selected)
Hydronic Heating
Gas #_Elec #_In -Floor _Wall Radiant_ Boiler BTUs ____ - , Localioll _—
Exhaust Fans (single
Bath #_Kitchen #.______Laundry # ._.._____Other
duct)
Fireplace I Gas #_Elec #_Other: #_ Location(s)
Dryer Duct
FORM C L:\Building New Folder 201MONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014