BLD20170315.pdf'�
icy 1, 4
STATUS: ISSUED 0
Expiration Date: 09/1
Parcel No: 00572400001
11111110111mimilm
JAMES MAI SSEN
2030487TH AVE W
EDMONDS, WA 98026-6619
VALUATION': $0.00
CITY OF' EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
000
APPLIC"ANT
UNIVERSAL APPLICATOR, INC
CONTRA(,' -1-014
UNIVERSAL APPLICATOR, INC
C/O GREGORY BRENNAN
515 S SOUTHERN ST
515 S SOUTHERN ST
SEATTLE, WA 98108
SUITE 329
SEATTLE, WA 98108
(206) 762-7500
(206)762-7500
LICENSE #: EXP:12/31/2014
;sidential heating oil tank
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE 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 APP ..CATION IS NOT PERMIT UNTIL SIGNED BY TIJJS RIALD[NO OFFICIAL Ott, HIS/HER DEPUTY AND ALL FEES ARE PAID
317120?
Signature Print Name Date Roeased By (Date
ATTENTION
IT ISUNLAWFUL 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/ IBCI 10/ IRC110„
ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUED BLD20170315
CONDITIONS
�n 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.
0, 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 of construction activity are exempt from the 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 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 from the issuance for this permit. Issuance ofthis 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.
INS PLCTIONS
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)°
FOR IMSPR'TIONS
III; 1,I)ING 425 771.0220 EXT'. T'. 1333 1 aO& NF XtNO415 771-0220 EXT.1326 FIM 425 775-772(1
PUBLIC WORKS 42251771-0235 PR&TREATMEVT 4251672-5755 RECYCLING (425) 2754801
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, andwhether you prefer morning or afternoon.
• F-Fire Final
P.4 �v 1.ssv_e.
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 51° Avenue N, Edmonds, WA 98020
t Phone 425.771.0220 Q 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 #:
�t A
2,07,(:74 a.7 � Ave
OOS72,4 00000oo
-v3• IB
,� �(
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
Associated Permit #:
�(J
APPLICANT: VN1V��lkl. �ililC:i-TQL.S� trJC'
Phone-
Z.o(,•li,-L•lSl7o 206.762.1157
Address (Street City. State, Zip): _5&A�ttL
E -Mail Address:
"A -t- wM 1/01 In oa. Go r^
PROPERTY OWNER: " �
MIhtSS�1
Phone: Fax:
J Inti
4ZS•-119.5",
Address (Street, City, State, Zip):'EDtMor D&, wA
Za 10,1 F37� /4v� fit/. 9f�Z
E -Mail Address:
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:* U N 1 V ( C.
Phone: Fax:
Lo6-762.75't!d a0c.•7b2.77CI
Address (Street, City, State, Zip): C,6_ VjA
.44 8 t a a
E -Mail Address: / 1
u ArL1 awl AA - A 40o . co vv -,—
WA State License #/Exp. Date: i a SI 17
*Contractor must have a valid City of Edmonds business license prior to doing work
1 -7 1 17 Z S—
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
PLUMBING MECHANICAL TANK 1XI
DEMOLITION
DETAIL THE SCOPE OF WORK: f- MM %. SS t 0" - 3�
� 6c,'L-0
S t'P kN lh� ore � t RC1 01 TR /�—
I N - t, �c� $�/ (`g4M
rlt,l.�
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: mm; t -�, i4"mU� Owner 0 Agent/Other X (specify): (0"7'P_AcToIP_
Signature: Date: ' 3• 2 047
FORM C LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
Type of structure to be demolished (e.g. house, shed, garage, etc.): _ _„
Floor area of structure to be demolished: sq. ft.
Critical Areas Determination: Stud R Conditional Waiver Waiver
Y Required �l ❑ ❑ ❑
PSCAA Case No. AHERA Survey done? (required) El
Additional comments:
FORMC LABuilding New Folder 2010MONE & x-ferred to L -Building -New driveTorm C 2014.docx Updated: 1/17/2014