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2587_001.pdfE bA,, CITY OF EDMONDS PHONE: (425) 771-0220 - FAX: (425) 771-0221 121 5TH AVENUE NORTH - EDMONDS, WA 98020 STATUS: ISSUED 10/10/2019 Pemdt#: BLD20191294 BUILDING PERMIT P ect Addtress.- 7631 212TH ST SW 4107--B3 Uxp "-+-. nAll fl/,)Aln EDMONDS Parcel No: 00614300001701 PROPERTYOWNER APPLICANT CONTRACTOR BLISS FERTILITY AND WOMEN'S MIKES PLUMBING MIKES PLUMBING HEALTH C/O INC OASIS 15516 129TH AVE NE WOODINVILLE, WA 98072 CIO SANDRA STOKES P.O. BOX 1535 EDMONDS, WA C/O SANDRA STOKES P.O. BOX 1535 EDMONDS, WA (206) 790-2227 (425) 890-9480 (425) 890-9480 LICENSE #: MIKESPL99OKM EXP:05/12/2021 JOB DESCRIPTION PLUMBIN2HAND SINKS. ***only includes sinks,no otherwork*** VALUATION: $0 PERMIT TYPE: Commercial PERMIT GROUP: 47 - Plwibing GRADING: N CYDS: 0 TYPE OF CONSTRUCTION: RETAINING WALL ROCKERY OCCUPANT GROUP OCCUPANT LOAD: FENCE: 0 X 0 FT-) CODE: OTHER: ------- OTHER DESC: ZONE NUMBER OF STORIES: 0 VESTED DATE NUMBER OF DWELLING UNITS: 0 LOT 4: lmlkxmxj� 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 .3 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 1BEDROOMS: 0 BATHROOMS: 0 1BEDROOMS 0 BATHROOMS: 0 FRONTSETBACK SIDESETBACK REAR SETBACK REQUIRED: PROPOSED. [REQUIRED: PROPOSED: IREQUIRED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O JRFQUIRED: PROPOSED: SETBACK NOTES: COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO OYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. ZCATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. Print Name Date Released By Date ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCUPANCY HAS BEEN GPANTFD. UBC109/ IBC I 10/ IRC 110. = RRE = APPILICANT = ASSESSOR = Crry STATUS: ISSUED BLD20191294 • Separate Permit Required For: anything out of this scope of work. • 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 thejob 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") fi-om adopted codes, ordinances or policies must be specifica4 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 fi-omthe noise limits of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and 10:00arn 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 5.30.120. • 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 fi-om 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. 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, SIDENALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6) BUILDING 1. Go to: www.edmondswa.gov 2. Then: Ser%Aces 3. Then: Perm its/Development 4. Then: Online Permit Info 5: If you don't have one already, create a login (upper right hand comer) 6: Schedule vour inst)ection Building Department Inspections are now scheduled online. If you have difficulties, please call the Building Department front desk for assistance during office hours. (425) 771-0220 ENG' NEERING (425) 771-0220 EXT. 1326 F1 RE (426) 776-7720 PUBLIC WORKS (425) 771-0235 RECYCLING (425) 276-4801 When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection — being requested, Contact Name and Phone Number, Date Preferred, and whether YOU prefer moming or afternoon. • B-Plumb Rough In • B-Plumbing Final 0 BUILDING PERMIT rmit #: APPLICATION Develonment Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: www.edmondswa.gov. PLEASE NOTE: Intake appointments are required for New Single Family Residences, Large Additions, ADU's, New Commercial, and Major Tenant Improvement application submittals. If plans are prepared by a profession- al, electronic files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please call 425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LCICATION: (Where the work is taking place) 'I r -31 - V'd v-1 (7, Job Site Address: ,0 "G Parcel Lot /Unit/Suite #: I 0_7 f3 Subdivisiow PROPERTY OWNER: Name: SAMIrz- /IrOOLAL- V+c.-y5c�-('4 MailingAddress: k5f5k(P II-2,r-14-Vx ^Vc "E - City/State/Zip: \/\J00PIt1AVk"-& W A I e0l -2- Phone #: - -1 '--10 - !Z� 2 Email OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? El Yes El No I own, reside in, or will reside in the completed structure. This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange according to RCW 18.27.090. Owner Signature: APPLICANT / CONTACT INFORMATION: Name of Applicant: '�9A-r4i;;'gg-A Mailing Address: r 0 V�C� I e, -3,5 City/State/Zip: \AJ'A- Iq 5C12-0 Phone #: Zt7_11�; - -I -1 15 - C-D 2- 4� % E- m a i 1: M I V-0-1 5 - e I LA r�lx 19 ( VAq e N'15111 - C_ OV" GENERAL CONTRACTOR: (if different from applicant) General Contractor: rAhVe-'s Pturv,\6t­��_�_ Mailing Address: FO f3c>Y, le5aF5 City/State/Zip: 54t-AOY-ekS WA Phone #: E-mail: STATE U B I #: �-q k V- F-S PC ql 0 V- t­1 CITY OF EDMONDS BUSINESS LICENSE #: t-UZ - Cr2UP WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: TYPE OF PERMIT (Provide Details on Page 2) El Accessory Structure/ 0 Addition Detached Garage 0 Demolition El Mechanical klumbing El New Single Family/ Duplex El Fire Sprinkler 11 Remodel • New Commercial/ Mixed Use 0 Re -Roof • Signs El Tank • Tenant Improvement El Other Remodel Permit fees are based on: The value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. Valuation: PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished El Unfinished 0 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT DESCRIPTION I certifV 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: Ono V-E Signature: Date fuz /11/ L/ GENERAL COMMERCIAL DATA Occupancy Group(s): Occupant Load(s): Type(s) of Construction: Fire Sprinklers: Yes El No El WA STATE ENERGY CODE: If your project affects the building envelope, mechanical systems, and/or lighting, you must complete the appropriate WSEC forms. DEFERRED SUBMITTALS: All commercial building permits that will require associated plumbing, mechanical, fire sprinkler, and/or fire alarm permits are applied for separately. TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet MECHANICAL EQUIPMENT COUNTS (New and Relocated) BTUs Gas Elec Other QtY A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct ExhaustFans Fireplace Furnace Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: PLUMBING FIXTURE COUNTS (New, Relocated or re -piped) QtY Qty Clothes Washer Tub/ Showers Dishwasher Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink Refrigerator Water Supply Hose Bibs Water Heater - Tankless? Y or N Hydronic Heat Water Service Line Sinks other: Toilets Other: GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)m BTUs City BTUs City A/C Unit Outdoor BBQ / Fire pit Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace L Other: MEDICAL GAS, AIR VACUUM COUNTS (New, Relocated or re -piped) QtY City Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: DEMOLITION Type of structure to be demolished: Square footage of structure to be demolished: AHERA Survey done? Y/N PSCAA Case #: I Critical Areas Determination: Study Required El Conditional Waive r El Waiver El Fill in Place El Fill Material: Removal Size of Tank (Gallons) Critical Areas Determination: Study Required El Conditional Waiver El Waiver El GRADE/FILL/EXCAVATE Grading: Cut _ cubic yards Fill cubic yards Cu / Fill in Critica! Area: Yes El No El GENERAL PROVISIONS APPLICATIONS: Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. LICENSING: All contractors and subcontractors are required to be licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License.