BLD20171624-APPROVED PERMIT.pdft'�ta
aCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE:'(425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 12/01/2017 �1
i 1 '
Expiration Date: 06/01/2018
Parcel No: 00565600100500
`O E. APPLICANT CONTRACTOR
HARRY POLL UNIVERSAL APPLICATORS INC UNIVERSAL APPLICATORS INC
18401 OLYMPIC VIEW DRIVE C/O KELLY MACKAY C/O KELLY MACKAY
EDMONDS„ WA 98020 51''S S SOUTHERN ST 515 S SOUTHERN ST
SEATTLE, WA 98108 SEATTLE, WA 98108
(206)617-7876 (206)762-7500 (206)762-7500
LICENSE'#: UNIVEA1087JI EXP:04/14/2018
JOB DESCRIPTION
Decommission 675 gallon underground residential heating oil tank in place by foam fill. 2 way polyurethane fill.
VALUATION::$0
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/ IBC1 10/ IRCI 10,
FIRE APPLICANT ASSESSORCITY
STATUS:
BLD20171624
• Fire Marshal must be present for tank work (fill, removal, or cap.)
• Final approval on 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") fi-om
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 fi•omthe 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 530.120.
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 fi•omthe issuance forthis 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. ;
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)
BUILDING ENGINEERING (425) 771-0220 EXT. 1326
1. „, , os ww-",- .. Buildi,l'd"i ri..
Go to: w.edmondswa.gov ng Department Inspections
2. Then: Services are now scheduled online. if you FIRE (425) 775-7720
3. Then: Permits/Development have difficulties, please call the
4. Then: "Online Permit Info Building Department front desk for PUBLIC WORKS (425) 771-0235
5:r If you don't have one already, create a assistance during office hours,
login (upper right hand corner) (425) 771-0220 RECYCLING (425) 275-4801
5: Schedule our inspection
When calling for an
being re uestec
0 F-Fire Final'
on please leave
ct Name and Pt
following information:' Permit Number, Job Site Address, Type of Inspection
Number, Date Preferred, and whether you prefer momin or afternoon,
OV
DEVELOPMENT SERVICES
PLUMBING, MECIIANICAL, 'T'ANK� & DLMOLITION
PERMIT APPLICATION
121 51` ,Avenue N, Edmonds, WA 98020
ig
s , Phone 425.771,0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO TLM PLUMBING & MEUUMCAL CREC LIST FOR SUBMITTAL REQUIREME�
PROJECT ADDRESS (Street, Suite ##y City Stare, Zip): Pfurcel #:
n
Associated permit At
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
APPLICANT Phone:
:; I,
�v -J #•t �r.9 /r oc..w * - �Z. 0 •-7I62•77
E-Mail Address'
..Address (Street, City, State, dip): :f__
;PROPERTY` OAR: Phone: ff Ix:.
'
E-Mail Address-
AddresStreet, itI�Se, Zip).
Cl p r rfC, 6r.J
Phone: Fax:
LENDING AGENCY-,
Address (Street, City, state, Zip): E-Mail Address:
Phone: I X"
CONTRACTOR:* »• 76 Z• 7 7 S
V Aj k v 6,44A-tom t ,
Address ('Street,„ City, State, Z'ip). E-Mail Address:i
�'UAA F
WA State License #/Exp_pate: k?-(
*Contractor -must have avalid Ctty of Edmonds' business license prior'to doing work 73 Z~ � f =
in the City. Contact the City Clerk's Office at 425,775-2525 City Business License #/Esp. Date;zoi 7
0 Z- st
pL�131NG MECHANICAL I'A1` DEMOLITION
«tea p t "r D E lu1 v,
]DETAIL THE SCOPE OF WORK
b
&A_
I declare under penalty of yerjrsry laws that the information I hove provided on this ft�a°mlappplication is `tN correct and camplete,
and that I am the property owner or duly authorized agent of the property owner to submit a permit apply"catlora ttr the +City of
,Edmonds. �
Owner. A'et:t/Otia er (specify):
Print Name:
❑
1 �l -7
Signature: J.
Date:. �......_. -
wricFon lJpdated 1/17/2014
FORMC L:�UIIDING)aMSIONFILES�DONE&x-ferredtoL-Building-N
60IL0 3917d d3S _1t/SN3AINn L5LLZ9L90Z 6T-ZT LT06/80/ZZ
Oxygen
Nitrous Oxide
.Medical Air
Carbon Dioxide
Helium
Medical —Surgical Vacuum
Other:
Type of Gas/Air/Vacuum System (new and relocated)
TOTAL OUTLETS
TANK #1
Method of Abandonment
..
Fill in Place Fill Material�tr®
Removal
Number of Gallons:
Critical Areas Determination_ Study Required
WANK ##2
Method of Abandonment
w Fill in Place L] Fill. Material
Ztemoyal s
Number of Gallons:
Conditional Waiver ❑ Waiver j
Type of Structure to be demolished (e.g. house, shed, garage, etc.); ........�
.........._
Floor area of structure to be dcmolished:— sq. ft.
Critical Areas Determination: Study Required Conditional Waiver 'Waiver
PSCAA Case No. AHERA Survey done? (required)
Additional comments: LL
Total#
FORM C L:\BUnLDING DIVISION FMBS\DONE & x4erred to L-Building New drivclForm C 2014.docx
60/80 39dd 173S-WS�GAINn ZSLLZ9L90Z
Updated; 1/17/2014
GE-TE LTOZ/80/ii
11/08/2017 11:15 2067627757
UNIVERSAL SEA
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