BLD20170251.pdft,,ITY OF EDMONDO
1215TH AVENUE NORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221'
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Expiration Date: ON/21/2017 1111j,
Parcel No: 00380300101000
DARYL L NELSON
MIKES PLUMBING
MIKES PLUMBING
8929 220TH ST SW
C/O NICOLE MARINEZ
C/O NICOLE MARINEZ
EDMONDS, WA 98026-8139
22219 97TH AVE W
22219 97TH AVE W
SETBACK NOTES:
EDMONDS, WA 98020
EDMONDS, WA 98020
THEREBY, NO PERSON WILL BE
(425)775-0201
(425)775-0201'
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27
THIS AP PIJ(`APJVNI IS N(;4 P
LICENSE #: MIKESPC99OKM' EXP:05/1 1)ZO 17
Replace e)asting water service line from meter to house
VALUATION: $0.00
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: ------- OTHERDESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNIT S: 0
ILOT #:
BASEMENT: 0' 1 ST FLOOR:'0
2ND FLOOR: 0 '' BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 3RD FLOOR: 0 GARAGE. 0 DECK: 0 OTHER`0
BEDROOMS:O BATHROOMS:0
BEDROOMS:0 BATHROOMS:0
REQUIRED:" PROPOSED:
REQUIRED: PROPOSED; REQUIRED: PROPOSED:
HEIGHT ALLOWEDO 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
THIS AP PIJ(`APJVNI IS N(;4 P
1'I' UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,
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/ IRCI I O;
ONLINE APPLICANT. ASSESSOR OTHER
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 51h 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 #:
2-C( ZZUTN 5T ;►�,1 Gy�InoNlOs wo
-Asgociated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: Phone: Fax:
I'« 0 1A)&N 25 77SCIzc
Address (Street, City, State, Zip): E -Mail Address:
MZ(<65 PL„ mFltN RNOp s0 .CO
PROPERTY OWNER: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
ZZ014' -S7 5 NAJ e 0 ()ejt� IIJ
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
CONTRACTOR:* Phone: Fax:
►n'ls I,, E
Address (Street, City, State, Zip): E -Mail Address:
ZZZl9 7TN AJE I/�, =D am ft] 05
WA State License #/Exp. Date:
*Contractor must have a valid City of'Edmonds business license prior to doing work „ K G 5 E C S Cy ..
in the City. Contact the City Clerk's Office at 425.775.2525 C.itBusiness License #/Exp. Date:
L al03 l
PLUMBING MECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK1PL-C....�iCG>..N ,........ V�.-.A�... ..,5...V...� C:.;
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.
i w L' Owner ❑ Agent/Other (specify):
Print Name ..�� ... �� .... � ��... -..w_ .... . P Y)w
Signature: � ��...�""� .�. .._.�.-... Date:
FORM C L:\Building New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
Fixture Type (new and relocated) Total # Fixture Type (new and relocated) Total #
Water Closet (Toilet) Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc) Water Service Line
Tub/Shower-�Drinking Fountain
_� ..
Dishwasher Clothes Washer
Hose Bib Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
.......... --._.__---
Water Heater Tankless? Yes ❑ No ❑ Hydronic Heat in: Floor ❑ Wall ❑
Floor D .......m_......._
..... .....
Drain/Floor Sink Other:
Refrigerator water supply (for water/ice dispenser) Other:
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #
E1ec #_Other:
w_-_,
# BTUs: <100k.._.--,, >100k_
Location(s),.,,,,,_,,_.,
.�
Air Handler / VAV
Gas #,_ym
Elec #
t)khr:
#, <10k—>lOk
Location(s).
.,,.,_,,,_ Locations):_...............-� �� � .... _. �......
(circle selected)
Boiler W- _-.m
BTUs:
,CFM:
Other: Nu_ .-.-.-.w.
AC / Compressor /
BTUs:..,.
Location('s):. .-.-........
Fireplace/Insert
BTUs:
Boiler / Heat Pump /
Gas #t .........Elec
#_Other:,,
__,,,,,- .
RE ......... BTUs:....... ......_<100k.......
100k -500k, ...... ........500k-lMil
Roof To Unit
P
HP:__<3 ......,
..............................
3-15, ..............................15-30
Location(s)
_ _..._....w
(circle selected)
TOTAL OUTLETS
Hydronic Heating
Gas #Elec
#_In
-Floor _Wall Radiant„_. Boiler BTUs:
Location.____
Exhaust Fans (single
Bath #
Kitchen # Laundry #
H„ f)tlter ---.. ._,.-- ,,
-______-
duct)
__
Fireplace
Gas #_Elec
#_Otlter:—
# I,ocatiou(s),....
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:
Location(s):
Furnace
.�
..-
BTUs:....
_ .. m _..... Location(s):..r ..._.. m
__. __-------�
Water Heater
BTUs: ��,
.,,.,_,,,_ Locations):_...............-� �� � .... _. �......
Boiler W- _-.m
BTUs:
.. Location(s)..............................._ww� ...
Other: Nu_ .-.-.-.w.
BTUs:..,.
Location('s):. .-.-........
Fireplace/Insert
BTUs:
Locations :,,,,„ m,
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
("ORM C LABuilding New Folder 2010\DONE & x-ferred to L Building -New drive\Farm C 2014.docx Updated: 1/17/2014