BLD20170706.pdf01a IxI.14
STATUS: ISSU
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1215TH AVENUE NORTH - EDMONDS, WA98020`
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Parcel No: 00548900000602
ANDREW T & STEWART ELIZAI
SERAFINI
810 9TH AVE N
EDMONDS, WA 98020
VALUATION: $0.00
C/O GREGORY BRENNAN
10350 N VANCOUVER WAY
SUITE 329
PORTLAND, OR 97217
(503)236-6359
UNIVERSAL APPLICATORS INC
C/O GREGORY BRENNAN
10350 N VANCOUVER WAY
SUITE 329
PORTLAND, OR 97217
(503)236-6359
LICENSE #:'UNIVEA1087JI EXP:04/14/2018
ill.
PERMIT TYPE: Residential
PERMIT GROUP`. 70 - Tanks/Fuel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION.
REQUIRED`. PROPOSED: REQUIRED:
i ACK
PROPOSED: REQUIRED: PROPOSED:
RETAINING WALL' ROCKERY:
PROPOSED:
OCCUPANT GROUP:
PERMP- APPROVAL
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 RELATINGTO
OCCUPANT LOAD:
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR'HIS/HER DEPUTY AND ALL FEES ARE PAID.
C%l/l.CQ�GILiIi
FENCE: 0 X 0 FT„)
Signature' Print Name Date'(Released
CODE:
OTHER: ------- OTHER'DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
(W 3&,;,II OF DWELLINGUNITS: 0
LO`l` #:
BASEMENT. 0 1 ST FLOOR: 0
2ND FLOOR: 0
13,ASEM NT 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:0 BATHROOMS:O
BEDROOMS:0 BATHROOMS:0
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/ IBCI 10/ IRC110„
ONLINE APPLICANT ASSESSOR OTHER
REQUIRED`. PROPOSED: REQUIRED:
i ACK
PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED`O PROPOSED:O REQUIRED:
PROPOSED:
SETBACK NOTES: _
PERMP- APPROVAL
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 RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR'HIS/HER DEPUTY AND ALL FEES ARE PAID.
C%l/l.CQ�GILiIi
W S � Z017
Signature' Print Name Date'(Released
By 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/ IBCI 10/ IRC110„
ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUED BLD20170706
CONDITIONS
• 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
occupancyinspections.
•' 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 from the noise limits''
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.
• 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, arisingdirectly, 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 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TBED NE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,, ETC,) WILL REQUIRE' SEPARATE PERMISSION.
PERMITTIME LIMIT: SEE ECDC 19.00.005(A)(6)
• F -Tank Inspection
MAY 2 3 2017 �bP Oo 1 -1-0-7 0
DEVELOPMENT,' SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, F imonds, WA 98020
Phone 425.771.02201t Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Ave, lel. r--nmdsvbs e,tA 96oz�o
Parcel #:
00 �-L4 91 o0000( --,OL
0
Associated permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
APPLICANT:
UNWE4AL. A-PpukcpvqgS, IPJL,
Phone.
77S7
Address (Street, City„ State, Zip):
E -Mail Address:
Pyoit-'00-
PROPERTY OWNER:
'� L 17- A B3-- i ST' w Ar— -r-
Phone: Fax:
) • t/ Z 5--- 5- 30, I d F.r
Address (Street,0City, State, Zip): A / � ^��r-S. cwA 9bo�
/V -
E -Mail Adm
LENDING AGENCY:
Phone:
Address (Strect, City, Statc, Zip):
E -Mail Address:
CONTRACTOR:*
�JN ld -S AVIV ACA- e --S , kNC .
Phone: Fax.
10 c' •-7621 .-7 zoo 7c-2.77)- 7
Address (Street. City, State, Zip?-
SOU Sr � -iTz.E , -j A- 'W05
E -Mail Address:
va 1..00. �
UAte_ �M� Co
WA State License li/lmxp. Date:
*Contractor must have a valid City of Edmonds business license prior ro doing work
J\� qtr P i 12(31 2e 11
in the City. Contact the City Clerk's Office at 425.775-2525
City Business License #/F-cp. Date:
PLUMBING ' MECHANICAL TANK
DEMOLITION
DETAIL THE SCOPE OF WORK: -a t�^ S S 1 p o O L-7&-trL-cj^
C rev '-"A
n/ r--- l tv
AA 1 ¢W
I declare under penalty ofperjury laws that the information I have provided on this form/applicadon 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.
l�
I�-� Al Owner ❑ A ent/Other &specify):1':xxt Name- g ,�....
Signature:.... ` Date:
FORM C L:\Building \New \'older 2010\DONE & x-feaed xo L-Bailding-New drlve\Form C 2014.docx, Updated: 1/17/2014
50/Za 39bd \73S -1t/Sa3AINn L5LLZ9L99Z 89:VT LTOZ/87,/90
Type of Gas/Mr/Vacuum System (new and relocated) Total#
Oxygen
Nitrous Oxide
Medical Air
Carbon Dioxide
Helium
Medical — Surgical VacuumOther:..._. .m...._._.
=TOTAL OUTLETS
TANK 41 TANK #2
Method of Abandonment Method of Abandonment
Fill in Place Fill Material — lc"q AM Fill in Place ❑ Fill Material
Removal Removal ❑
Dumber of Gallons: 3100 C-7A-*—" Number of Gallons:
Critical Areas Determination: Study Required [j Conditional Waiver ❑ Waiver
Type of 'structure to be demolished (e.g. house, shed, garage, eta),
Floor area of structure to be demolished: sq. ft.
.. ............. _
Critical Areas Determination: Study Required ❑ Conditional Waiver Waiver
PSCAA Case No.Survey done? (required) ❑
Additional comments:
FORD C i-;laullding New Folder 2010NDONE & x-ferred to 1-80ling-.New driveTonn C 2014,docx Updated: 1/17/2014
50/80 39Vd V3S-dSZ1311INn L5LL7,9L90Z 89:bT LTOZ/8Z/90