20170613121351.pdfov
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
I So 1)
STATUS: ISSUED 06/13/2017 Pernjit#: BLD20170785
Expiration Date: 12/13/2017 llmject Address: 19407 81 ST PL W, EDMONDS
Parcel No: 00572600000900
RICHARD D ELWOOD CASCADE WEST TANK SERVICES CASCADE WEST TANK SERVICES
19407 8 1 ST PLACE WEST CIO VICTORIA BLOOM C/O VICTORIA BLOOM
EDMONDS, WA 98020 18527 28TH AVE NE 18527 28TH AVE NE
LK FOREST PARK, WA 98155 LK FOREST PARK, WA 98155
(425) 776-9586 (206) 364-6214 (206) 364-6214
LICENSE #: caseavA862c8 EXP:08/15/2018
PUMP OUT 300 GHEATINGOIL TANK TRIPLE RINSE AND FILL W/ SAND. CAP OFF ALL TANK PIPING
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 70 - Tanks/Fuel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY
OCCUPANT GROUP
OCCUPANT LOAD:
FENCE: OXO FT-)
CODE
OTHER: ------- OTHER DESC:
lZONE-.
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER �OF DWELLING UNITS: 0
LOT #
0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
� 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER 0
JBEDROOMS-. 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
FRONTSFrBA('K S1DLSFrBA('1% REA R S F1'B ACK
REQUIRED: PROPOSED: IREQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED�O IREQUIRED PROPOSED:
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
TikJAPPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUI LDING OFFICIAL OR HISMER DEPUTY AND ALL FEES ARE PAID.
0(,1131Z017
le- 112-at —7
Print Name Date Released EW Date
v ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/IBCIIO/IRCIIO.
ONLINE APPLICANT ASSESSOR OT11ER
STATUS: ISSUED BLD20170785
CONDITIONS
• Final approval on a projector 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.
Approval of any plat or plan containing provisions which do not comply with city code and forwhich 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.
SoundNoise originating fromtemporary construction sites as a result of construction activity are exempt from the noise litnits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00prn 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 in interests, agrees to indemnify defend and hold
hanniess the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for darriages of
whatever nature, arising directly or indirectly fromthe issuance for this permit. Issuance ofthis 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.
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.
PERMITTIME LIMIT: SEE ECDC 19.00.005(A)(6)
CALL FOR INS PECTIONS
BUILDING (425) 771-0220 EXT. 1333 ENGINEERING (425) 771-0220 ID(T. 1326 1-FIRE025) 775-772
I PUBLIC WORKS (425) 771-0235 1 PR&TREATNIENT (425) 672-5755 T -RECYCUNG (425) 27548�
When calling for an inspection please leave the folio-Aing information: Permit Number, Job Site Address, Type of Inspection being
reques te(L Contact Name and Phone Number, Date Prefereed, andvibether you prefer niorni n(_, or afternoon.
0 F-Tank Inspection
Phone#
Site Info
Date arne
N
Address
Email
Vacant Pets Owner? -
Tank Location ljoaLle 7d'nUw*,J—j Fill pipe above grade
1)
Total Depth Fill Pipe- Diameter 3 0
Contents: Oil Water
Field Notes
A
Other
Ko 7
Agent
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" (P DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 Yh Avenue N, Edmonds, WA 98020
<:St. Phone 425.771.0220 9 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR S UBMITIAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite # ity State, Zip):
�j
Parcel #:
P107 jJL
Q 6000c';070,-)
F
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? YesE] NoA
APPLICANT*,,
-0,
Phone: "'40&
q�� _
Fax: ek"O 6
._,4
'Se"
Address (Sircet. City, State. Zliw;
E-Mail Address:
PROPERTY OWNER:
P.01� ".Ik-- -IL.) C.;0 a
Phone:
'-) 7 61 re6
Tax.,
Address (Street, City, State, Zip):
/
E M 'I Address:
- , _7� I
LENDING AGENCY:
Phone:
:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Admess*
NVA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
&0_5cc',WT-
City 13usiness License #/Exp. Date
N t�� —/) �7 L�,/ 0
in the City. Contact the City Clerk's Office at 425.775.2525
NnNM11�WHE[M1E0L6NWi
PLUMBING MECHANICAL
TANKI I DEMOLITION I I
300
DETAIL THE SCOPE OF WORK:
C_ 4� T,
L
Li L
R,
I declare underpenalty ofpedury laws that the information I have provided on thisformlapplication 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.
2
Print Name-
Owner F-1 AgentlOthei (specify):
Signature:
Date:
IN
EWA
FORMC LABuilding New Folder 2010\DONE & x-ferred to I -Building -New drive\Form C 2014.docx Updated: 1/17/2014
FORM C LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.doex Updated: 1/17/2014