BLD20140932.PDF�o�tl��
CITY OF EDMONDS
121 5TH A VENUE NORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 09/22/2014
Expiration Date: 03/22/2015
Parcel No: 00513105800500
MARGARET L EBERT
MARGARET L EBERT
MARGARET L EBERT
16031 75TH PL W
16031 75TH PL W
16031 75TH PL W
EDMONDS, WA 98026-4524
EDMONDS, WA 98026-4524
EDMONDS, WA 98026-4524
(425)743-1726
(425)743-1726
(425)743-1726
LICENSE #: EXP:
INSTALL GAS PIPING FOR TWO OUTLETS. FURNACE AND WATER HEATER TO BE INSTALLED LATER.
n h.
VALUATION: $0.00
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PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
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 #:
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS:0 BATHROOMS:O
BEDROOMS:0 BATHROOMS:0
REQUIRED: PROPOSED: REQUIRED: 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.
HIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,
By
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE Ot'
OCCUPANCY HAS BEEN GRANTED, UBC109/ IBCI 10/ IRCI 10,
ONLINE F2APPLICANT ASSESSOR OTHER
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STATUS: ISSUED
BLD20140932
• Separate Permit Required For: FURNACE AND WATER HEATER WHEN INSTALL®.
• In addition to the required pressure/relief valve, an approved listed expansion tanks hall be installed on all hot water tanks. Per
UPC 608.
• Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
• 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 fromtemporary construction sites as a result ofconstnuction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of7:00amto 6:00pmon weekdays and 10:00amand 6:00pmon 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 fromthe issuance for this permit. Issuance of this pen -nit 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.
PERMITTIME LIMIT. SEE ECDC 19.00.005(A)(6)
CALL FOR INS PECTIONS
BUILDING 425 771-0220 IXT. 1333 INGINEMING 425 771-0220 EXT. 1326 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.
• B-Gas Test/Pipe
• B-Plumbing Final
2014-09.18 06:38
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8774495794 >>
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of DMDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITIONPERMIT APPLICATION
121 5t4 Avenue N. Edmonds, WA 98020
Phone 425.771'.0220 2 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE. PLUMBING d MECHANICAL C•HEC'KUST FOR .5UHMWI A1. Rt,'QUIREMEN7''
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PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
-Iv PC. tom% �`l� 'aivl� WR �o2b
Amociated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes Nu
APPLICANT:
,�ti '�3! rZi
Phone-
�iys �Q347Z 4
Fax:
Address (Street. City, State, Zip):
16011 75 'V PC W
F-Mail Address:
To Pa L-13 a sa-r LoC- , w-
PROPERTY OWNER:
Phone:
Fax:
Address (Street. City, State, 'Zip):
E•Mail Address:
LENDING AGENCY:
•
Phone: Fax:
Address (Street, City, State, 'Lip):
FAa-il Address:
CONTRACTOR:-
Phone:
hax'
Address (Strut, City, State, Zip):
h-Mail Address:
WA State License N/Exp. Date:
`Contacc for mast have a valid City vl E'dmunda business lic•enie prior to doing work
City Business License #/Exp. Dutc:
in the Cirv. Contact the City Clerk's office fit 425, 775.2S25
PLUMBING I MECHANICAL TANK
DEMOLITION
DETAIL THE SCOPE OF WORK:
t- S /L...1.
0.,1, ke _ r.7 V i t k� % • %'/i/�S
I declare under penalty of perjury laws that the information I have provided on this form/application is true, correct and complete,
and that l am the property owner or duly authorized agent of the property owner to submit a permit application to the City of
Edmonds.
PrintName: 1L614 4<%7" �� Owner Agem/Other ❑ (specify):,
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Signature: .4 �..c.Date: ��— 2 O /�
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FORM C IARuilding New Folder 201000N! & x-ferret to "uilding-New driveTorm C 2014.&C'
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U*ted: 1/1712014
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2014-09-18 06:39 8774495794 >> P 212
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Fbmwe Type (thew anti rdoeated)
Total #
• F rture Type (new and relocated)
Total #
Water Qow (Toilet)
Pressure Reduction Valveftessure Regulator
ShA (Lkebm laaadry, lavatory. bar. eye wash, etc)
Watttr Service Line
Tub/Shower
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Bac0ow Prevention Device (e.r, RavA, DOW AM
Water Heater Tankless? Yes ❑ No ❑
Hydronic Heat in: Floor ❑ Wall ❑
r
Floor Drain/Floor Sink
Other:
[Refrigerator water sullply (tor wsterAct dispenser)
Other:
Equipn*nt Type
Appliance/Equlpnwnt Information (new and relocated)
Total /►
Furnace
Gas 4_Elec #_Other: #— BTUs: <IOOkY >100k` Location(s)
Air Handler/ VAV
Gas #_F,lee #—Other: N CFM: <10k—>IOk_, Location(s)
(circle selected)
—
AC / Compressor /
Boller / Heat Pump / '
Gas NElee #_Other: N— BTUs: ._<100k, 100k-500k. 300k-IMII
Rir►f Top 11nit
Hp: <3, 3-15, 13-30 Location(s)
(chyle selected)
Hydronic Heating
Gm #_Elee #_In -Floor Wall Radiant— Boller BTUs: Location
Exhaust Yens (single
Rath #_Kitchen #---Laundry # _Other: N- —
duct)
•
Fireplace
Gas N_ Etec #_Other: #— Location(s) _
Dryer Duct
s
Appliance Type
AppliancefEquipment Information (new and relocated)
Total #
AC Unit
BTUs: _ _ _-. Locatlon(s):
Furnace
BTUs: 711� K A T"tion(s):
Water Heater
BTUs: 1 Locatio s):f Gi�� �✓%
'Location(s):
i'
Boiler
HTUs: _
Other:
Fireplace/Insert
BTUs: iocation(s): _
BTUs: Location(s):
Stove(Range/Ovea
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•
Dryer
Outdoor BBQ a
TOTAL OUTLETS
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FORM C I.:\RuildinI New Foldcr 20I0\WNL & x-fetred to l.Building-New drive\Forst C 2014.docx Updated: 1/11/2014
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2014-09-19 05:22 8774495794>>
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EXEMPTION FROIV CONTRACTOR
REGISTRATION 'VERIFICATION
FORM D
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to the City of Edmonds that:
0 Value of work under $500.00. The -aggregate contract price of labor and materials and all
other. items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that lie/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090(9).
0 Owner who contracts for a project. A prpperty owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or sell' improved property that he/she has owned for
less than twelve months. RCW 18,27,090(111
Work performed personally on own property. Anyone personally working on property
he/she owns, or at which he/she resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
0 Use of own employees. Property. owner using, him/herself or his/her own employees to
perform maintenance, repair, and alteration work in or upon his/her own property. RCW
18.27.090(13).
0 Licensed Architect, engineer, electrician br plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
0 Other. Specify which provision of RCW 18.27.090 applies:
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THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES 4
THAT ALLY INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND/ACKNOWLEDGES THAT *IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE �
BUILDING PERMIT WILL BE D&,4EDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this., day of �� 0-
PROPERTY OWNER/AUTHORIZED WITNESS
PERSON _
Y
1 Signature
tz�
Print Name t Name
f
LATEMPWILDINMHANDOUTS REVISED IN 2009\PREVIOUS HANDOUTSWORMSICONTRACTOR EXEMPTION FORM
D.DOCREViSM 7107
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