BLD20130023.PDF1!1
v/
OF EDM
Inc. t 890
CITY OF EDMONDS
Expiration Date: 07/08/2013
Parcel No: 00434600000401
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
EDWARD & GAIL GIROUX FOX PLUMBING & HEATING FOX PLUMBING & HEATING
8727 OLYMPIC VIEW DR 7501 2ND AVE S 7501 2ND AVE S
EDMONDS, WA 98026 SEATTLE, WA 98108 SEATTLE, WA 98108
(425)712-6520 (206)713-6520 (206)713-6520
LICENSE#: FOXPLH*163LO EXP:11/16/2013
JOB DESCRIPTION
REPLACE GAS FURNACE LOCATED IN THE GARAGE.
VALUATION: $0.00 COMPLETED
PERMIT TYPE: Residential
PERMIT GROUP: 40 - Mechanical/Solar
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: N 0 X 0 FT.
CODE: 09
OTHER: N -----OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
maw
�ILIONLXMT
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
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK SIDE SETBACK REAR SETBACK
REQUIRED: PROPOSED: REQUIRED: PROPOSED: UIRED: 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.
THIS APP IC 10 NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER PUTY AND ALL FEES ARE PAID.
Print Name Date
Date
ATTENTION v
IT IS 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/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR OTHER �, (Roo
STATUS: ISSUED
BLD20130023
• 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.
• Provide combustion air per IMC Chapter 7 for commercial and multi -family residential installations, and IRC Chapter 17 for
one and two-family dwellings.
• 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 from the noise limits
of ECC Chapter 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 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 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.
• Installation, use and maintenance of equipment and components shall be per manufacturer's specifications, installation
instructions, and applicable state codes. Provide manufacture's installation instructions on site for Building Inspector.
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)
BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 1
PUBLIC WORKS 425) 771-0235 1 PRE-TREATMENT 425 672-5755 1 RECYCLING (425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
beine requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer mornine or afternoon.
• B-Mechanical Final
OF EDM
O�
v _ DEVELOPMENT SERVICES
PLUMBING & MECHANICAL, TANK & DEMOLITION
PERMIT APPLICATION
121 50'Avenue N, Edmonds, WA 98020
�Sr I gqo Phone 425.771.0220 2 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
9-7Z' 01w•KC_ vtt", b6-e
w4 AZd
Parcel #:
APPLICANT: C,6,vvS-6pkw t,etw V�
Phone:
Lo6--t.C'S - 65 zv
Fax:
-.r.- -76&- z56�f
Address (Street, City, State, Zip):
E-M it Address:
L a,rt1-S / Q
PROPERTY OWNER: �d 6I'r-O�x
Phone:
1{u,— Z(Z.— jj5-7/
Fax:
Address (Street, City, State, Zip): �� W,p� UCCA rUr
ql LIL4
E-Mail Address:
LENDING AGENCY:
—
Phone:
Fax:
r
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* r-OX toiK% K�
Phone:
z��-zro�-331�
Fax:
z.�6-z6�,-may
Address (Street, City, State, Zip): 7 5a ( 7L.k4 S
$��'Efcee L.+ q*tob
E-Mail Address:
;:�?1c U'j+_ f c wA
*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
WA State License #/Exp. Date:
fi)�Q Pam+'* `( `i 6 0-7
City Business License #/Exp. Date:
PLUMBING (,MECHANICAII TANK DEMOLITION
�JIF- L i (c - Z-(-tc Ater qu
Cnu c ! rcts Y.
I declare underpenalty ofperjury laws that the information I have provided on this forWapplication 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: C1ktlL s4VV1'+-V Owner Agent/ er (specify):
Signature: Date:
FORM C C:\Users\PauMppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\9LS805MQ\Form C.doc Updated:
8/2011
60= 1
Type of structure to be demolished e.. house, shed, garage, etc.):
Floor area of structure to be demolished: s . ft.
Critical Areas Determination: Study Required Conditional Waiver Waiver
Additional Comments:
TANK #1
TANK #2
Number of Gallons
Number of Gallons
Method of Abandonment
Method of Abandonment
Fill in Place Fill Material
Fill in Place Fill Material
❑ Removal
Removal
Critical Areas Determination: Study Required Conditional Waiver Waiver
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
# I
Gas #
Elec #
Other: BTUs: <100k2 >100k
Location
Air Handler/AC/VAV
#
Gas #
Elec #
Other: CFM: <100k >100k
Location
Boiler/Compressor/
Heat Pump/Roof Top
Unit
#
HP:
Gas #_Elec
<3,
# Other: BTUs: <100k,
3-15, 15-30 Location
100k-500k, 500k-1Mil
Hydronic Heating
#
Gas #
Elec —In-Floor,
Wall Radiant, Boiler BTUs:
Location
Exhaust Fans (single
duct)
Location: #Bath
#_Kitchen
# Laundry # _Other:
Fireplace
#Gas
#
Elec #
Other: Location
Other
Number of Outlets
Fixture/Appliance Type
AC Unit --------- BTUs:
Location:
Furnace
BTUs:
ton.
Water Heater
BTUs:
Location:
Boiler
BTUs:
Location:
Fireplace/[nsert
BTUs:
Location:
Stove/Range/Oven:
Dryer
Outdoor BBQ:
Other:
TOTAL OUTLETS
FORM C C:\Users\Paul\AppData\Loca]\Microsoft\Windows\Temporary Internet Files\Content.Outlook\9LS805MQ\Form C.doc Updated:
8/2011