BLD20170705-APPROVED PERMIT.pdfPERMIT TYPE. Residential
CITY OF
EDMOND
TYPE OF CONSTRUCTION:
OCCUPANT GROUP°
OCCUPANT LOAD,
FENCE ( 0 X 0'FT,)
OTHER: ------- OTHER DESC:
CODE:
ZONE: -
121 5TH AVENUENORTH - EDMONDS, WA 98020
VESTEDDATE;
PHONE: (425) 771-0220
- FAX: (425) 771-0221
STATUS: ISSUED
06/05/2017
BUILDING PERMIT
Expiration Date: 12/05/2017
„�
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Parcel No: 00559700300400
ROPE 1 R
APPLICANT
CONTRACTOR
JOHN D CHRISTENSEN
UNIVERSAL APPLICATORS INC
UNIVERSAL APPLICATORS INC
21709 97TH AVE W
C/O GREGORY BRENNAN
C/O GREGORY BRENNAN•
EDMONDS,;WA 98020
10350 N VANCOUVER WAY
10350 N VANCOUVER WAY `
SUITE 329
SUITE 329`
PORTLAND, OR 97217 "
PORTLAND, OR 97217`
(503)236-6359
(503)236-6359
LICENSE #: UNIVEA1087J1 EXP:04/14/2019
JOB DESCRIPTION
Remove and replacement
VALUATION: , $0.00,
of300 gal underground residential heating oil tank`.
Tankto be in same location.
PERMIT TYPE. Residential
PERMIT GROUP: 70 - Tanks/Fuel
GRADING: N CYDSI0
RETAINING WALL ROCKERY;
TYPE OF CONSTRUCTION:
OCCUPANT GROUP°
OCCUPANT LOAD,
FENCE ( 0 X 0'FT,)
OTHER: ------- OTHER DESC:
CODE:
ZONE: -
NUMBER OF STORIES. 0
NUMBER OF DWELLING UNITS: 0
VESTEDDATE;
LX[S]ING AREA
BASEMENT: 0 1 ST FLOOR 0 2ND FLOOR 0
13RD FLOOR 0 GARAGE 0 DECK: 0 OTHER 0
PRO POSED AREA
BASEMENT. 0 1 ST FLOOR 0 2ND FLOOR 0
3RD FLOOR. 0 GARAGE: 0 DECK: 0 OTHER. 0
BEDROOMS0 BATHROOMS0
IBEDROOMS.0 BATHROOMS0
FRONTSETBACK SIDESETBACK
REOUIRED� PROPOSED 1EOUIRED PROPOSED° REQUIRED PROPOSED
HEIGHT ALLOWED:O PROPOSED 0 IREQUIRED PROPOSED;;
SETBACK NOTES
APPROVALPERMIT
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 1`8:27,:;
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR'HISMER DEPUTY AND ALL FEES ARE PAID,
Signature Print Name Date;' Released y Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED UBC109/ 1BC1 10/ IRCII D
ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUEDBLD20170705CONDITIONS
• 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.
• 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 from temporary construction sites as a result of construction activity are exempt 'fromthe noise Emits
of ECC Chapter 5.30 only during the hours of 7:00am to 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.
0 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 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)
PUBLIC WORKS 425 771-0235 1 PRE-TREATMENT 125),672-5755 I RECYCLING (425) 275-4801
When calling for an inspection please leave the following information; Permit Number, Job Site Address, Type of,Inspe
reou6gted. Contact Name and Phone Number. Date refereetic andwhether vou urefer moroi wig or afternoon.
F -Tank' Removal
F -Tank Replacement
RECEIVED
MAY .2 3 2017
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, 8L DEMOLTI'ION
', G
pE, RMIT AppLXCATION
121 5'' Avenue A Edmonds, WA 98020
t. Phone 425.771..0220 2 Fax 425.771..0221
City of Edmonds
PLEASE REFER To THE PLUMBING & MECHANICAL CHECKZJST F01z 3 UBM17TAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, Caty State, Zip):
17" AV er-_ W - q try 7—
IS THIS WORK ASSOCIATED WITO ANOTHER PROJECT? Yes ❑ No
APPLICANT: U N \ V e," A L-
Address (Street, City, State, Zip):
PROPERTY OWNER_
50 �
Address (Street, City, State, Zip):
Lw -7o �l 7ri xv,;_,At
Address (Street, City, State,
CONTRACTOR-.*. ,
Address (Street, City, State, ZIP)'
L4 A
LO
1160 Zo
mfflvlwl�
/G
*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
I"
Parcel #:
q `10010
Associated Permit #:
Phone:
7-616-761- •7 rm
E. -Mail A.ddess-
uP�Z .
Phone:
z-5. -7-71. e--ilM
F,Mail Address
E --;sail. Address:
Fax:
&66•X2,•7757
:). car 1,
Pax,
Fax:
Phone: Fax:
I -o .16?-, -S`oo Zc�,- 762 -7757
E -Mail Address:
WA State License #/Exp. Date: tZ(3 7
City Business License #/Exp. rate:
!el _ 11233- rZ t
__._. p
DETA EL THE SCOPE OF WORK:
A
NA
[ /16 ic, 7"AA&-
TA-A/ K— TZ) TS t. 2�P`sl v�..� I S✓4'�' Z,-fj 4,1-r(o.J .
I declare under penahl of perjur.Y laws` that the irVormation I have provided on this formlapplic-liO t 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_ Owner ❑ Agent/Other , (specify):
Signat>ltt:
•" Date:
FORM C L:\Building New Folder 201MDONE & x-fenW to LrBuilding-Ncw drive\Fonn C 2014.doex Updated, 1/17/2014
LOItO 39tid 173S _1VSZ1311INn LSLLZ9L90Z 9S:CT LTOZ/CZ/SO
Type of structure to be demolished (e.g. house, shed, garage, etc.):
Fiooz area of structure to be cleturtoti fixed: __.. �s�t> ft'
Critical Areas Determination: Study Required Conditionat Waiver LJ Waiver
PSCAA Case No.
Additional Comments:
AHERA Survey done? (required) El
FORM C L \Building New Folder 2010\DONS &-ferred to t -Building -New dries Worm C 20Mdocx
L0/90 39vd V3S-1VSd3AINn LSLLZ9L90Z
Yipdauxl_ 1117/1014
99:ET LTOZ/92150
05/23/2017 13:56 2067627757 UNIVERSAL SEA
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