BLD20170167.pdfPERMIT 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 1 ST FLOOR: 0 2ND FLOOR:'0
3RD FLOOR: 0 GARAGE: Or DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE 0 DECK`. 0 OTHER. 0
BEDROOMS:`0 BATHROOMS:0
BEDROOMS: O'. BATHROOMS: O:
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 RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
°A`IIIS APPLICAI IO IS NOT APER `" UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID
Bggglature Frjnt Name Date ReleasddBy Date
ATTENTION
ITIS 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/ IRC110;,,
ONLINE APPLICANT ASSESSOR OTHER
STATUS: IS
BLD20170167
• Pursuant to UPC 605.2 a water service shutoff shall 'be installed on the water line as it enters the building.
• City approved plastic piping may be used in water service piping provided that where metal water service piping is used for
electrical grounding purposes, replacement piping shall be of like materials (UPC 604.8). A state electrical permit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of Labor &
Industries Electrical Division at 425-290-1309.
•: Final approval on a project or final occupancy approval must be granted by the Building Official priorto 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.
0; Approval of any plat or plan containing provisions which do not comply with city code and for which avariance '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 7:00amto 6:00pmon weekdays and 10:00am and 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 inderrmify 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 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.
• Refer to'City of Edmonds Water service line handout for approved pipe materials, inspections and other requirements.
• Owner/Contractor to provide Water Service Line asbuilt.at final inspection. See City Standards for requirements.
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)
PUBLIC WORKS. 425 771-0235 111WMEA T 42 672-5755 WNCLING 42 275-41101
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
reauested Contact Name and Phone Number, Date Prefereed, andwhether you prefer morning or afternoon.
• E -Water Service Line
City of Edmonds
5-01 7-01 U ?
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 9 Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
-Z 3 (o 2-1 ., A 0 C V
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: Phone: Fax:
Addresssss ( trcct, Cit State, Zi _ E -Mail Address:
�'( y, P) _.�,
.01 0062-0
PROPERTY OWNER: Phone:
Address (Street, City, State, Zip): E -Mail Address:
LENDING AGENCY:Phone: Fax:
( 'w e,
. � �, Zip): E -Mail Address;
)
Address (Street, (""id' Stat
IS
CONTRACTOR:* Fax:
lA L L) M ,. Phone: .. �
Address (Sircet, City, State, Zip): E -Mail Address:
WA State License #/Exp. Date:
*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 City Business License #/Exp. Date:
PLUMBING MECHANICAL TANKJ.j DEMOLITION
DETAIL THE SCOPE OF WORK: _._._-- R ��
ATL 12
_................�f 2 �r .......
C)�C �1vJ__ ....�....�� .� i �f2 s� RJS
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
Edmonds.'
Print Name: �� V_❑
... �� v, ��"�.'�.�, r..�.....�' , Owner A gent/Other (specify)-,
Y)a „�_w�......�.......� .-_.
,. .,.. '�
°:'° ate:
Signature: D
_ � "_ .._ � �..... _ _—_.�.. ..._.
FORM C L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.docx Updated: 1/17/2014
xture Type (new and relocated)
PWater
Total #
Fixture Type (new and relocated)
Total #
oset (Toilet)
Pressure Reduction Valve/Pressure Regulator
............�
��-����(_..�
........ ...... y
Slnk kitchen, laundry, lavatory, bar, e e wash, etc.)
Service Line
' Water Se
Tub/Shower
HP ................ _<3, , I-15, .... .........15-30 Location(s)
Drinking Fountain
(circle selected)
Dishwasher
��
Clothes Washer
Gas #_Elec #_In -Floor _Wall Radiant_ Boiler BTUs: Lora*ati4ptr, ,.
Hose Bib .........�a_m...--
Exhaust Fans (single
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes ❑ No ❑
Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
Ll I MKI 111161011 MAI
Equipment Type Appliance/Equipment Information (new and relocated) Total #
Furnace II Gas # Elec #_Other: # BTUs: <100k_ >100k— Location(s)
Air Handler / VAV
#_CFM: <10k_ >10k_ Location(s)
Gas #_Elec #_Other:______._......._........._
(circle selected)
_
AC / Compressor /
Boiler / Heat Pump /
Gas #_Elec #_Other:,_.._ ............. #_ BTUs: ......_____ w.<100k, _,.............. .,.... ,100k -500k, 500k-1Mil
Roof Top Unit
HP ................ _<3, , I-15, .... .........15-30 Location(s)
(circle selected)
Hydronic Heating
Gas #_Elec #_In -Floor _Wall Radiant_ Boiler BTUs: Lora*ati4ptr, ,.
Exhaust Fans (single
Bath #_Kitchen # Laundry # —Other._ .....�.,m. ..�._.� ....... ..............�,.
.-_
duct)
Fireplace I'' Gas #_Elec #_Other: # Location(s)
Dryer Duct
FORM C L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.docx Updated: 1/17/2014