BLD20170720-APPROVED PERMIT.pdfCITY OF EDMON'DS
121 5TH AVENUE NORTH-"EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
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` nrir ii arrnr Jprrr nrrrtlt po4ijwuIjilINO,, ISSUED 05/30/2017"1��iml/ur
BUILDING PERMIT
Expiration Date: 11/30/2017.%
Parcel No 0043440.1500602
.,, E. y.APPLICANT CONTRACTOR
KENNETH & SANDRA BELLINGHAM EDMONDS BAKERY DURNIN PLUMBING INC
1505 10TH PL N C/O KENNETH &'SANDRA C/O JAMES'DURNIN
EDMONDS, WA 98020 BELLINGHAM 23701 102ND PL W
1505 1 OTH PL N EDMONDS, WA 98020'
EDMONDS, W A 98020
(206)818-3768 (206)818-3768 (206)546-4940
LICENSE 4: DURNIP1901 DZ EXP:03/09/2018
DESCRIPTION
Relocate gas line in back of bldg.
VALUATION: $0.00
PERMIT TYPE Commercial PERMIT GROUP: 47 - Plumbing ,
GRADING N CYDS 0 TYPE OF CONSTRUCTION
RETAINING WALL. ROCKERY, OCCUPANT GROUP
OCCUPANT LOAD
FENCE: ( 0 X 0 FT J CODE°
OTHER: ------- OTHER DESC: ZONE
NUMBER OF STORIES 0 VESTED DATE:
NUMBER OF DWELLINGUNITS: 0 LOT #,
F-XISTING AREA PROPOSED AREA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR 0 BASEMENT 0 1S 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:0 BEDROOMS 0 BATHROOMS:0
FRONTSETBACK SIDESETBACK
REQUIRED PROPOSED; REQUIRED° PROPOSED REQUIRED, PROPOSED
HEIGHT ALLOWED:0 PROPOSED:OREOUIRED� PROPOSED:
SETBACK NOTES:
PERMIT 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 111"FIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,:
S/3%/7
Signature 1' ihl NaTre Dala Re aced 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, UBC] 09/ IBC] 10/ IRCI lou
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ONLINE APPLICANT ASSESSOR OTHER /A ,'
STATUS: ISSUED
BLD20170720
• Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
• Final approval on a project or final occupancy approval must be grantedby the Building Official priorto use or occupancy of
the building or structure. Checkthe 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.
0.
r Approval of 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 aresult of construction activity are exempt fi•omthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon 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 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 (4 5),771-0235 PR&TREATAEIT i4-.15) 672-5755 1 RECYCLING`(425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
requested, Contact Name and Phone Number, Date'Prefereed, and whether you prefer morning or afternoon.-
B-Cras Test/Pipe
B -Plumbing Final
City of Edmonds
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
I ,Sl REFER TO THE PLUMBING &MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
t czi u a. 1i <si- S
Associated Permit #:
No
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ® ❑ ao l(p D
APPLICANT: Phone: Fax:
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City, State, Zip 1?-Mi�qq.��cddress;
Address (SSlsect, Ci
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PROPERTY OWNER: Phone:Fax:
R j- Z,rmw S-ri' (JVfo FFA-. � 1
Address (Street, City, State, Zip): E -Mail Address:
�
S I-vNkl[ (�S AAL„
LENDING AGENCY: Phone: Fax:
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Address (Street, City, State, Zip): E -Mail Address;
CONTR�A^CTO�J}R\�:* t '/\(C /� , `q t/� � Phone: y1F�ax:
l r” o 1 • 1 11 ` I V Lk l 1
Atitires �attecl, Cil, State, Zlp):�� �� E -Mail Address:
A7 YJ A State License #/Exp. Date:
*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 City Business License #/Exp. Date:
PLUMBINGMECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK ............. ............ .... ..
..r I o c��_.._ .......__. ...W ..� ......._......._.. _.— ................
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:...�;� _._ ... O�nt.,1° Agent/Other ❑ (specify) _.. _ ............ _.
Signature: Date
FORM C LAB uildin g New Folder 201 MONE & x-ferred to L -Building -New driveTorm C 2014.docx Updated: 1/] 7/2014
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PLUMBING FIXTURE COUNT
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
�6.._.....�
Ho....... _ ........
se Bib
Backflow Prevention Device (e.g. aBPA, DCDA, AVB)
.......
Water Heater Tankless? Yes ❑ No
..........
....... ._..�... .�.�
Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM C L:\Building New Folder 2010\DONE & x-ferred to IrBuilding-New drive\Form C 2014.docx Updated: 1/17/2014