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20170126140945.pdf4.m� uITY OF EDMONDS, 1215TH AVENUE NORTH-'EDMONDS, WA 98020' PHONE: (425) 771-0220 - FAX: (425) 771-0221 Parcel No: 00641500000600 MARIA SHNEERSON 14119 NE 71 ST ST REDMOND WA 98052 (425)246-7762 VALUATION: $0.00 MARIA SHNEERSON OWNEREXEMPTION 14119 NE 71ST ST C/O MARIA SHNEERSON REDMOND, WA 98052 14119 NE 71ST ST REDMOND, WA 99052 (425)246-7762 (425)246-7762 LICENSE # EXP: T BYPRIOR OWNER W/ OUT PERMIT. NO GROUND DISTURBINGAcrIMTY. REQUIRED: PROPOSED`. REQUIRED: PROPOSED: REQUIRED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED: SETBACK NOTES: I AGREE TO COMPLY WITH CITY AND STATELAWS 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 ° 1115'APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR IIVVfI) R.DEPUTY AND ALL FEES ARE PAID s� - I L. -- 9�� ha1ure Print Name Date Released By Date ATTENTION MS 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/ I RC1110. ONLINE APPLICANT ASSFSSOR 'MTIIER lV�S TATUS: BLD20170135 • 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. r; • 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 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 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 5.30.20. « Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indernnify 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 fromthe issuance for this permit. Issuance of this pen -nit 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. 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. When calling for an inspection please leav ee e,'SUA Contact Name and PI B-Final Demolition PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)CALL FOR INSM"FIONS FNGINEEMG 425 771-0220 EXT, 1326 PRE-TRF.AT ENT -4 5 672-5755 the following information: Permit Number, Job Site RE (L25„775-7720 CLING (l2ij 275-4801 Type of Inspection being w'or afternoon. "., a DEVELOPMENT SERVICES PLUMBING, MECHANICAL, TANK, & DEMOLITION PERMIT APPLICATION ^st i r1 121 5`h Avenue N, Edmonds, WA 98020 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 #: -6 Z06 j I,- 'W Associated Permit #: IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No APPLICANT: Phone: Fax: It Z 7/ Address (Street, City, State, Zip): E-Mail Address: 1 NE '7�� S' ��Wjo, Lv� o._S/IC, E� 9Licb, PROPERTY OWNER: Lhone: ax: 0\✓,0, Sv\n��SO� 25 2�C 7i - Address (Street, City, State, Zip): E-Mail A dress: 20 (0 ,MaSA 9� q 00, Co _I INNDI AGENCY: Phone: 1"t. t rss (Street, City, State, Zip): E-Mail Address: Co 'i` "'1"(Ikl:* 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 Lj DEMOLITION ` _ DETAIL THE SCOPE OF WORK:._L..... " �G ., ........ it u c� �e � t I ald :------ ©lr ...�._� ...! .... �...__......_ �..... _° WA ))v. _..._✓� v� O�..ow�. h I4L a.�. u ._.:_.._..... �.. C t I declare under penalty r„' perinry lanh that the information I have p bided 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: cl--:�.... 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 Type of Gas/Air/Vacuum System (new and relocated) Total# Oxygen Nitrous Oxide Medical Air Carbon Dioxide Helium Medical — Surgical Vacuum Other: TOTAL OUTLETS TANK #1 TANK #2 Method of Abandonment Method of Abandonment ....... .. ... ....... ... Fill in Place ❑ Fill Material--—_.. Fill in Place ❑ Fill Mate++rial,_ _..... ,mp. ........�__....... — Removal n Removal Number of Gallons:_ m.._.. _.� Number of Gallons: ... ..............mm .__ ....—............. Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Type of structure to be demolished (e.g. house, shed, garage, etc.): .L-m _ _ v .............. Floor area of structure to be demolished. Critical Areas Determination: Study Required Additional comments: Conditional Waiver ❑ Waiver ft. FORM C LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.doex Updated: 1/17/2014