20160317090236.pdfCITY OF EDMONDS
1215TH A VENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425)'771-0221
Expiration Date: 09/17/2016
Parcel No: 27040700403000
KAREN ERNST
SOUTH COUNTY PLUMBING
SOUTH COUNTY PLUMBING
7619 175TH ST SW
C/O KURT MUSTARD
C/O KURT MUSTARD
EDMONDS,WA 98026-5021
PO BOX 6157
PO BOX 6157
EDMONDS, WA 98026
EDMONDS, WA 98026
(425) 754-9130
(425)754-9130
LICENSE 4: SOUTHCP19302 EXP:08/26/2016
INSTALL NEW WATER SERVICE UNE, MEPER TO HOUSE. ROUTE LINE UNDER GARAGE SLAB.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP°
OCCUPANT LOAD:
FENCE: 0 X 0 FT
CODE:2012
OTHER: ---=--- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 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: 0 '
BEDROOMS: 0 BATHROOMS: 0
REQUIRED: PROPOSED' REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED.O PROPOSED.O RE UIRED. PROPOSED.
SETBACK NOTES:
ULM
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 18:27,
j2
I:IS APP .1 I"I0N,IS.NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,
hkiji JohilS 3/1 2 16
Signature " Print Name Date Released By bate
ATTENTION
MS 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/ IBC 110/ IRC I 10.
ONLINE APPLICANT ASSESSOR EK OTHER
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 A Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): $(57—G
Parcel #:
,I-1Pn ta6h)W � q\Al, Uj f 1
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No P
Associated Permit #:
APPLICANT:
Phone: Fax:
Address (Street, City, State, Zip):
E-Mail Address:
PROPERTY OWNER:
Phone: Fax:
Address (Street, City, State, Zip): ` D
.� • Wed
E-Mail Address:
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* ho Fax:
Address (Street, City, State, Zip): ,, -- ll Q� _••• " "Address:
11 C.. W TIZD16
Cito5q- WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing svork
in the City. Contact the City Clerk's Office at 425.775.2525 City Busihess License #/'F X]), Date:
PLUMBING MECHANICAL TANK I.j DEMOLITION
DETAIL THE SCOPE OF WORK:
.......... n, ........� .. ........ .............
.
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: . ..__ _.w ......._. Owner ❑ s ecifSignature:
m� Date:1bw/Otfier
._ w
FORM C LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014
PLUMBING
Fixture Type (new and relocated)
FIXTURE COUNT
Total # Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.) ._. .e.n
Na...............
_Water Service -Lt ........ .........................................................--...............
ne
_........-..n
Tub/Shower
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e.g. RBPA, 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:
Equipment Type
MECHANICAL
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #—Elec
#,-_-Other:,
---. BTUs: <100k,-.,,,, >100k-,-.,.,.,
Location(s), ,,,,
Air Handler / VAV
Gas #
#,,,,,
# CFM: <10k >10k
Location(s),
(circle selected)
mElec
_,other:,_ .-------
,_ - _ ,.,,_,
AC / Compressor /
Boiler / Heat Pump /
Gas #
Elec #,_Other:
# BTUs:, _........ _ ........ _...... <100k,
100k-500k ......... 500k-Mil
Roof Top Unit
HP
<3 ............3-15
15-30 Location(s),_,,,,
(circle selected)
Hydronic Heating
Gas #
Elec #-,,,,,,,,,,,-In-Floor
_Wall Radiant„m,m,m,,, Boiler BTUs:._,m,m,m,mm„m,m,m,m,m,m,m,,,,,,m,.
Location_,mm,m,mmmm,m,m,m,m,m,....mmmmm,........,m,m,m,m,m,m,m,m,mmmmm,,,,,m,
Exhaust Fans (single
Bath #_Kitchen
#_Laundry #
duct)
Fireplace
Gas #,..
_..Elec #.,
Other: # Location(s)................_....._......_..
......_......_.................................--.......
Dryer Duct
Appliance Type
7BTUs:
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:.
ea_ Location(s)�.............................�.�.�..............�.........
Furnace
_,-----------------------
- Location(s) ,
___ ....-......
_____.......
..........................................----
Water Heater
BTUs:
Location(s)�:_www_...
Boiler
BTUs: ......,.,�..--.,,...,,.,
_ Location(s)wH_._...._ ..._.�.-.-_______...-�..
_.----
Other:
BTUs:....
Fireplace/Insert
BTUs: ........................-
Location(s)................................-..__-_...................._............................-�-.__ �_....�.. ..P.
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
FORM C.' L:\Building New Folder 2010\130NE & x-ferred to L-Building-New drive\Form C 2014.doex Updated: 1/17/2014