BLD20170708-APPROVED PERMIT.pdf0, ITYOF EDMONDS
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121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425)'771-0220 - FAX: (425) 771-0221'
STATUS: ISSUED 05/31/2017_y �i ���` f rlrlll 111»YI111f »», »,«!«ffm
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Expiration Date: 12/01/2017 » f �» f » » ' �, j f I
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PROPERTVOWNER.
APPLICANT
DONNA J WILLIAMS
TANKS BY DALLAS
8610 MAIN ST
C/O VON GIGRICH
EDMONDS, WA 98026
17552 BALLINGER WAY:NE
LFP, WA 98155-
(206)365-0291
1
Pump contents, triple rinse and fill in place 1 300 gal VST
VALUATION: $0.00
CONTRACTOR
TANKS BY DALLAS
C/O VON GIGRICH
17552 BALLINGER WAY NE
LFP, WA 98155-
(206) 365-0291
LICENSE #: TANKSD*OOIKF EXP 05/06/2019
APPROVAL
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,
IS APPLICATION IS NOT A:PERMIT 'UNTIL SIGNED BY THE BUILDING
OFFICIAL OR HIS/BER DEPUTY AND ALL FEES ARE PAID,
Signature Print Name Date" Released B 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, UBC] 09/ IBCI 10/1RCI 10,
= ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUED BLD20170708
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'
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.
Approvalof 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 6:00pm 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 fromthe 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.'
INSPECTIONS
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.
• F -Tank Inspection;
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DEVELOPMENT SERVICES
MAY
A) NG, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
BUVII 121 5'h Avenue N, Edmonds, WA 99020
City of Edmonds Phone 425.771.02201t Fax 425.771.0221
PLEASE REFER TO THE PLUMBING& MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel
I A _yy iA
. ......... .
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yeso
Nobo Associated Permit #:
APPLICANT: . ...... . ,P•hone;
Fax:
Address Slreelji, ('11y"Stale, zip)r
x
'PROPERTY
( ess, 777
E -Mail Ad'("
?
OWNER:
Phone: ax:
S
Address (Street , City",Niatc, Zip):
)'JIA
E -Mail Addressr-, "'q "'0"
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:*
Phone: Fax:
Address Mreo, City, State, Zip):
E -Mail Address- A
UA 17 �
1 118d (0"
WA State License 1141 xp. Date:
*Contractor intisr have a valid City of Edmonds business license prior to doing
work
in the Cit),. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
PLUMBING MECHANICAL TANK DEMOLITION . . ........
DETAIL THE SCOPE OF
. . .. ..........
.... . . .. ..... ..
...... .. . .....
................ . . . . . ........ . .
I declare under penalty of perjury laws that the information I have provided on this form/application is true, correct and complete,
and that am the properly owner or duly authorized agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name; c: Owner Agent/OtherjV(specify):
-LAL- 'K "6111
Signature: ------ Date:
FORM C L:\B.ildi.g New Folder 2010\DONE & x-ferred to L -Building -New driveTorm C 2014.doex Updated: 1/17/2014
Fixture Type (new and relocated)
Total #
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Air Handler / VAV
Pressure Reduction Valve/Pressure Regulator
Elec #_Other:
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)mmmmm^^
Location(s)__
Water Service Line
_...... ..... _
__..._..................
Tub/Shower
.m
Location(s): a_„ �.....
. .............. _ . . . .....
Drinking Fountain
...... ..���..
�.........
Water Heater
..... .. . ...........
Dishwasher
AC / Compressor /
Clothes Washer
..��..................................__...._.....................................�.......
Hose Bib
�.�.��._. �...............................�. � .... ..........
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Boiler / Heat Pump /
................................
Water Heater Tankless? Yes ❑ No ❑
..
...... .-------- �. _.__
Hydronic Heat in: Floor 0 Wall ❑
100k -500k, 500k-1Mi1
. .......... wwww....�.................
Floor Drain/Floor Sink
���m m. �_.
Other:
<3,
g ............... _
Refrigerator supply (for water/ice dispenser)
Location(s):,_ ....
O_._.
Other:
(circle selected)
Equipment Type
Furnace
Gas #_
Elec #,—
Appliance/Equipment Information (new and relocated)
Other:,_ — #_ BTUs: <100k_ >100k_ Locatlorl(s) .....,� ...
Total #
Air Handler / VAV
Gas #
Elec #_Other:
# CFM: <10k_ >10k
Location(s)__
m,
Furnace
(circle selected)
m�.._...�
BTUs: .�_....._
.m
Location(s): a_„ �.....
. .............. _ . . . .....
�.........
Water Heater
AC / Compressor /
_.._. Location(s). .................... .,, ..... ......
Boiler
BTUs:..�
Boiler / Heat Pump /
Gas #_Elec
#_Other:
#_ BTUs: <100k,
100k -500k, 500k-1Mi1
....
Location(s):�
Roof Top Unit
HP:
<3,
3-15, 15-30 Location(s)
Location(s):,_ ....
(circle selected)
Dryer
Hydronic Heating
Gas #Elec
#
In -Floor _Wall Radiant_ Boiler BTUs:
Location
Exhaust Fans (single
Bath #_Kitchen
# Laundry # 01lier
# .
duct)
_. as
Fireplace
Gas #_Elec#_Other:
#_ Locadurot(s),
y �......,., ..........
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs: r„
... ......... Loa:ation(s):... ......... - ...
_..._
m,
Furnace
m�.._...�
BTUs: .�_....._
.m
Location(s): a_„ �.....
. .............. _ . . . .....
�.........
Water Heater
BTUs:
_.._. Location(s). .................... .,, ..... ......
Boiler
BTUs:..�
...� ..�..._-Location(s):... �.......�
Other:....��...........
�
BTUs:
....
Location(s):�
Fireplace/Insert
BTUs:
Location(s):,_ ....
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORMIC LABuilding New Folder 201000NE & x-ferred to L -Building -New driveTorm C 2014.docx Updated: 1/17/2014
FORMC LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
SOIL SAMPLES
mm
SITE ADDRESS
PHONE .-***REFERRED BY
EMAIL
ANIMAL _ S Y4 VACANT�fN WATERi9N POWER&/N
TANK SIZE.._FILL PIPE: . ...... DIAMETER 3 _7 TOTAL.
LAY OF TANK LENGTH tGROUND COVER
_\J�t FILL GRADE
CONTENTS OIL WATER OTHER X-- TOTAL _JE -
WHAT TRUCKS CAN WE BRING TO THIS SITE?
OFFICE NOTES: mom!
FIELD NOTES:
DA
JOB COMPLETED L'
Site info taken by:—,--,--