BLD20140565.PDF8
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
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PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 06/13/2014Pe�rtnit #. �RET,n,2�n1°4O5f_5�
Expiration Date: 12/13/2014 Project Address ,.18812''`OLYMPIC VIEVW bR,;
w � � EDMONDS
Parcel No: 27031300400600
PROPERTYOWNER APPLICANT CONTRACTOR
BOB SWERK TANKS BY DALLAS TANKS BY DALLAS
PO BOX 745 17552 BALLINGER WAY NE 17552 BALLINGER WAY NE
EDMONDS, WA 98020 LFP, WA 98155- LFP, WA 98155-
(344) 3 54-6 122 (206)365-0291 (206) 365-029 1
LICENSE #: TANKSD**OOIKF EXP:05/06/2015
FILL IN PLACE WITH SAND/SLURRYAN 882 GALLON UST
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: ( 0 X 0 FT.)
CODE: 12
OTHER: ------- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
ILOT #:
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 IST 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
tEQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
4EIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
;ET BACK NOTES:
PERMIT APPROVAL I
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.
'HIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
Liar (a 7hoi-iiLyift 17kme /3, Zalt�
Signature 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 OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR )4 .1 —,
OTHER
STATUS: ISSUED
BLD20140565
• Fire Marshal must be present for tank work (fill, removal, or cap.)
• 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 orpolicies 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 i0:00am 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 fordamages of
whatever nature, arising directly or indirectly fromthe issuance forthis 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
t" DEVELOPMENT SERVICES
PLUMB NG, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
Fst 7 $9p 121 5d' Avenue N, Edmonds, WA 08020 .
City of Edmonds Phone 425.771,0220 It Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City StEate, Zip):
Parcel #:
iL .
IS THIS WORK ASSOCIATED WITH ANO R PROJECT?
Yes [_j No
Associated Permit #:
APPLICANT.''--'"� j � �
Phone: jC(Q p, .Fax: �l�t�
Address Street, , S t ,Zip): � , t �
r (� �
� �
E-Mail Address: + �...��
PROPERTY OWNER . O k.f
Phone:. i} Fax: f„
_
Address (Street, C' , State, Zip):
E-Mail Address:
bDb<S M • C..
LENDING AGENCY:
,
Phone: Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*- h- 1
Phone: Fax:.
Address (Street, City, State, Zip):
E-Mail Address:
*Contractor must have a valid City of Edmonds business license prior to doing work
WA State License #/Exp. Date:.
�}�
in the City., Contact the City Clerk's Office at 425 75.2525
C'ty usiness 'tense #/Exp. D te:
3t �o
PLUMBING MECHANICAL
TANK, DEMOLITION
DETAIL THE SCOPE.OF WORK: !F(1 / I
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I declare under penalty of perjury 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
Edmonds.
property owner to submit a permit application to the City of
Print Name:. iHn Owner ❑ Agent/Other (specify):
Signature % ""'^�---'' Date: ip %
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FORM C L-\Building New.Fo)der 20101DONE & x-feared 10 L-Building-New drive\Form C 2014.docx
Updated:1/17/2014
Type of Gas/Air/Vacuum
System (new and relocated)
Total#
Oxygen.
Nitrous Oxide
Medical Air
Carbon Dioxide
.Helium
Medical — Surgical Vacuum
Other:
TOTAL OUTLETS
s
TANK #1
TANK #2
Method of Abandonme t
Method of Abandonment
Fill in.Place
Fill Material
Fill in Place ❑ Fill Material
Removal ❑
I Removal ❑
Number of Gallons:
Number of Gallons:
Critical Areas Determination: Study Required
❑ Conditional Waiver ❑ Waiver ❑
Type of structure to be demolished. (e.g. house;shed, garage, etc.}:
Floor area of structure to be demolished: sq. ft.
Critical Areas Determination: Study Required ® Conditional Waiver ❑ Waiver ❑
PSCAA Case No.
AHERA Survey done? (required) ❑
Additional comments:
R.
FORM C L:1Building New Folder 201000NE & x4we d to L-Building-New driveTorm C 2014:docx Updated: 1/17/2014
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