BLD20161362.pdfaC E b ko
IT"' Y y 0' "DMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED
Expiration Date: 04/14/2017
Parcel No: 00573200001300
Fill and place 300 gallon UST
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 70 - Tanks/Fuel
GRADING: N CYDS: 0
DONNA J MILLARD
TANKS BY DALLAS
TANKS BY DALLAS
22702 NE 60TH ST
C/O VON GIGRICH
C/O VON GIGRICH
REDMOND, WA 98053-8101
17552 BALLINGER WAY
17552 BALLINGER WAY
NUMBER OF STORIES: 0
LAKE FOREST PARK, WA 98155
LAKE FOREST PARK, WA 98155
ILOT #:
(206)365-0291
(206)365-0291
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
LICENSE, #: TANKSD*OO1KF EXP 05/06/2017
Fill and place 300 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:
OTHER:-------OTHERDESC:
ONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
ILOT #:
EXISTING AREA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PRO PO S ED AREA
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
BEDROOMS:0 BATHROOMS:O
1 BEDROOMS:0 BATHROOMS:0
FRONT S ETBACK SIDESETBACK
REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
PERNUT APPROVAL
I AGREE TO COMPLY WITII 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 PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/I3ER DEPUTY AND ALL FEES ARE PAID.
C q� i0/i-'1/zai(
Signature Print Name Date Released Oy 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 GRANTED. UBC109/ IBC110/ IRCI 10.
= ONLINE = APPLICANT = ASSESSOR = OTHER
STATUS: ISSUED
BLD20161362
• 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. Checkthe 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") fi•om
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 fiom 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 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating fi•om 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 fi•om 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, 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 PRE-TREATMENT 425 672-5755 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
• F -Fire Final
lu
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5'h Avenue N, Edmonds, WA 98020
Phone 425,771.0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
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9Q*1
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes
Phone: jZ'0):t4 =:—�
10
Fax: 2
Address (Street, City, State ,ip):�
E -Mail Address:
Phone:
Address (Street, C' t
te, Zih-Mail
<
Address:
I
LENDING AGENCY:
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Phone:
Address (Street, City, State, Zip):
E -Mail Address:
CONTCTO=R*
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Phone-,,6
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Address (Street,
E -Mail Addres:_
It
I declare under penalty of perjury laws that the information I have provided on this form/application is true, correct and complete,
and that Iam the property owner or duty authorized agent of the property owner to submit a permit application tothe City of
Edmonds.
Print Name: VDA 6S H1Q1Wridq Owner El Agent/Othery (specify): �04m4vc
Signature: Date:
FORM C LABuilding New Folder 201 MONE & x-ferred to L -Building -New drive\Forrn C 2014.docx
Updated: 1/17/2014
F®RMC L:\Building New Folder 20lOWONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
LOCATE SOIL SAMPLES
RECORD -SEARCH COMPLETED
SITE ADDRESS w, LZ 4,
LL -0
PHONE 'REFERRED BY
EMAIL
LOCATION OF TANK ANIMALS N(�') VACANTN
FILL PIPE: DIAMETER— TOTAL
LAY OF TANK FILL ABOVE/BELOW GRADE LENGTH
TANK SIZE GROUND COVER
MATE POWER Yo
CONTENTS OIL WATER OTHER
TOTAL
,
FIELD NOTES: ')
\7.) \vj,
C,3--
JOB COMPLETED Y: A
Site info taken by: —Deadline
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