BLD20130839.PDFV�
�y OF EDAf
° CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 08/05/2013 ( Permit #: BLD201
Expiration Date: 02/05/2014 (Project Address: 9211 OLYMPIC VIEW DR, EDMO
Parcel No: 27031300100800
E
111A
DANA GRAVES
UNIVERSAL APPLICATORS INC
UNIVERSAL APPLICATORS INC
9211 OLYMPIC VIEW DR
2357 S E 50Th Ave
2357 S E 50Th Ave
EDMONDS, WA 98020-2396
Portland, OR 97215
Portland, OR 97215
(425)778-5259
(503)236-6359
(503)236-6359
LICENSE #: UNIVEA1087JI
EXP:04/10/2014
i DESCRIPTION
DECOMMISSION TANK, FILL
WITH GRAVEL.
VALUATION: $0:00
COVIF L--ETE:u
Eft
PERMIT TYPE: Residential
PERMIT GROUP: 70 - Tanks/Fuel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: N ( 0 X 0 FT.)
CODE: 12
OTHER: N -----OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
1 VESTED DATE:
NUMBER OF DWELLING UNITS: 0
1 LOT #:
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
1 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
REQUIRED: PROPOSED:I RE UIRED: PROPOSED: I REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O I REQUIRED: PROPOSED:
SETBACK NOTES:
1 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 APPLICATION IS NOT A P TIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
Name Date
ATTENTION
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/ IBC110/ IRCI 10.
= ONLINE = APPLICANT = ASSESSOR OTHER
01
STATUS: ISSUED
BLD20130839
• Fire Marshal must be present for tank work (fill, removal, or cap.)
• 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.
• 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.
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
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
being requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
F-Tank Inspection
City of Edmonds
DEVELOPMENT SERVICES
PLUMBING & MECHANICAL, TANK & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 2 Fax 425.771.0221 /
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESSI (Street, #, City State, Zip): 1�
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Parcel #:
APPLICANT:
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Phone:
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Fax:
'2.2t -7G2_
Address fStreet, City, S te, Zip):
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E-Mail Address:
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PROPE�/TW�NR:
Phone:
2
Fax:
Address Strreeeet,(City, State Zip):
.. L
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
Address (Street, City,State Z. ) %i
1 J c`�k-�4-�n�..i . � j�
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 Office at 425. 775.2525
WA State License WExp. Date:
�+� i u1 W � 1 17,-3 1 2.013
City Business License #/Exp. Date-
PERMIT APPLICATION FOR:
❑ PLUMBING ❑ MECHANICAL TANK ❑ DEMOLITION
I declare under penalty of perjury laws 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 Edmo ds.
Print Name: `� ❑ Owner gent/Other (specify):�2 1 M'4'-4
Signature:. Date: t7'�
FORM C LABuilding New Folder 2010\130NE & x-ferred to LBuilding-New drive\Form C.doc Updated: 8/2011
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