20170706132744.pdf0 �. E Q Al
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 07/06/2017 4: BLD20170022
BUILWNC', PERMtT
Expiration Date: 01/02/2018 Project.kddre.s.s: 8911 196TH ST SXV. EDINIONDS
Parcel No: 27041800301600
GALEN W & SANDRA L DOLSTAD GALEN W & SANDRA L DOLST AD FISCHER PLUMBING
8911 196TH ST SW 8911 196TH ST SW C/O TERRY CLINTON
EDMONDS, WA 98026-6329 EDMONDS, WA 98026-6329 1115 NW SIST
SEATTLE, WA 98107-
(425) 774-1786 (425) 774-1786 (206) 783-4129
LICENSE #: FISCHPCI 3 1 RI EXP.02/22/201 8
REPAIR WATER SERVICE LINE IN GARACE.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD
FENCE: OXO FT)
CODE: 2015
JOTHER: ------- OTHER DESC:
[ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR- 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
FRONTSETBACK SIDESETBAUK RLAR SE`TBACK
REQUIRED: PROPOSED: LREQUIRFI) PROPOSED REQUIRED: PROPOSED
HEIGHT ALLOWED:O PROPOSED:O [REQUIRED: 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
[IS APPLICATION ISNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR ffl_�IIIER DEPUTY AND ALL FEES ARE PAID.
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re Print Narne Date Released By
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/ IBCI W/ IRCI 10.
ONLINE APPLICANT = ASSESSOR OTHER
STATUS: ISSUED RLD20170922
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. Cbeck the job card for all required City inspections including finalproject 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 s ites as a result of construction activity are exempt from the noise limits
of ECC Cbapter 5.30 only during the hours of 7:00am to 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 Clapter 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
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.
INSPECTIONS
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.
PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)
EXT. 1333
I PUBLIC WORKS (425) 771-0235 1 PR&TREATMENT (425) 672-5755 1 RECYCLING (425) 2754801 1
When calling for an inspection please leave the folloAng information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
* B-Plumb Rough In
* B-Plumbing Final
(P
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
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 #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No�6
Associated Permit #:
APPLICANT:
Pljonc:
4 9-0.�-7-74. V7T
ax:
Address (Street, Cit�, State, Zip):
2� —I
E-Mail Address:
PROPERTY OWNER:
P one:
AzEr--1-7J4
t7
Fax:
Address (Street, City) State, Zip):
nq I I tq(,-q�
E-Mail Address:
q,ErG AGENCY:
Phone:
Fx
s (Street, City, State, Zip):
E-Mail Address:
CO
,NTRACTOR:*
VP_ (_ Ll PAIQLn,�V
Phone:
Fax:
Aadress (Street, City, State, Zip): U
E-Mail Address:
*Contractor must have a valid City of Edmonds business license prior to doing work
in the City. Contact the City Clerk's Oytce at 425.775.2525
WA State License #/Exp. Date:
ess License #/Exp. Date:
PLUMBING MECHANICAL TANK
DEMOLITION[
DETAIL THE SCOPE OF WORK.
I AO gaico4p, -
(�j �j
I declare underpenalty ofperjury laws that the information I have provided on this formlapplication 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 Owner Agent/Other El (specify):
Signature: Date: Z -Cfe- k7
FORM C LABuilding New Folder 2010\130NE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014