20170209154814.pdf/d Tp
CITY OF EDMONDS,
1215TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 02/09/2017 �111J� �!lill��h'11111JU�1.111 III,�IIJII1��JI���I���11f` ��II���IIIIIIIIIIl11111U��iil�U1i11�����J� V'1 N'„,J'jl 1
UPON
Expiration Date: 08/09/2017TINJIM"ll''' �a l Mim I Moll!
, ,�� ���; r
Parcel No: 00767200110200
KATHLEEN HOBSON
KATHLEEN HOBSON GREENWOOD HEATINGAND AC
1024 5TH AVE SUNIT A1'02
1024 5TH AVE SUNIT A102 C/O GREENWOOD HEATING
EDMONDS, WA98020-4082
EDMONDS, WA 98020-4082 825 S STACY ST
SEATTLE, WA 98134-
(206)465-7919
(206)465-7919 (206)784-1818
LICENSE 4: GREENHA922D7 EXP:03/27
REPLACE WATER, HEATER
VALUATION: $0.00
- ---- - ---- 7
REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED'0 PROPOSED:O RE UIRED: PROPOSED:
SETBACK NOTES:
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
Wi,IltKMl N'S ('OMPENS TION IN'SURANCli, AND RCW 1837.
THIS APPLICATION IS NOT A POWIT UNTIL SIG ED BY THE BUILDING OFfICTAL OR UIS/HFKPEPUTY AND ALL FEES ARE PAID
p e Rint Name Date H [e ed 0 Date
ATTENTION
IT IS 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/ IBC110/ IRCI 10.
ONLINE APPLICANT ASSESSOR 2 OTHER ��
ATUS:IISSUED
5210
• In addition to the required pressure/relief valve, an approved listedexpansion tank shall be installed on all hot water tanks. Per
UPC 608.
• Final approval on a project or 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.
+w 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"
ofECC 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 avariance has been granted pursuant to'ECC 5.30.1120.
• 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.
• Installation, use and maintenance of equipment and components shall be per manufacturer's specifications, installation
instructions, and applicable state codes. Provide manufacture's installation', instructions on site for Building Inspector.
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.
PERMITTIME LIMIT: SEE'ECDC 19.00.005(A)(6)`
-n calling for, an
ict Name and Phone Numlx
'• B-Plumbing Final
Date f"referee and whether youtwefer morning,or afternoon.
W
4r DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 9 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
1 ®2,+ i�7<ki A-v e., s-,-o A -1 �0� 11
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT:Phone: Fax:
200
( Y � "T :dip): /] '
Address St et C't , `l —/ y,-y E-Mail Andre �
PROPERTY OWNER: l� one: Fax: l
Address (Street, City, State, Zip): 1 k E-Mail Address:
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip):. E-Mail Address:
CONTI (°'(.IR:°& Phone: Fax:
l
Address (Street, City, State, Zip): E-Mail Address:
WA Slwde;License li 411, �1:1'
*Contractor must have a valid City of Edmonds business license prior to doing work ���� �.
in the City. Contact the City Clerk's Office at425.775.2525 City Btlstness License #/E matt.
PLUMBING MECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK: _ ... —� �..:..., ...f _ C"
�' .. .. .......w . .._,_......_. -w r..,. ....._ _. �.
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: - �wm::.'M'. ... OVA. OwnerJX Agent/Other ❑ (specify) _......_ _......_..........
Signature: ,.� Date Z
_ ..... _._ ........ 7
FORM C L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.doex Updated: 1/17/2014
PLUMBING FIXTURE C
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/ShowerWW Drinking Fountain
Dishwasher ................................._. Clothes Washer
.................. ............_. �.
Hose Bib Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heate
-------- ....................................
�
r Tankless? Yes ❑ No Hydronic Heat in: Floor ❑ Wall ❑
Floor Drain/Floor Sink Other:
Refrigerator water supply (for water/ice dispenser) Other:
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #
Elec #_Other
: _ _
# BTUs: <100k_ >100k_
Location(s) ,,,,,,,,,,�..____
Air Handler / .IV
Gas #_Elec
#_Othr
r°:,w.,_
# CFM: <10k,___. >10k_
Location(s),
(circle selected)
_.....................
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_ Boiler BTUs:., --- _
. Location.,,,,.. _........
Exhaust Fans (single
Bath #_Kitchen
#_Laundry #
....--.,0tlrcr..... .___ ---___W..�..�m,_
duct)
Fireplace
Gas #_Elec
#_Other:
# Location(s)_w_ -,,,.,_,,
_,...._. _
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:
Location(s)3...-- ._.... .
�.. ......
Furnace
—�
....,.�
BTUs:
-µLocation(s): ,,,.- , __..... .
-- �n_
Water Heater
BTUs:
„�. _ Location(s):, m .,,,--- ..__. ._ �...-.._
---
.....
Boiler
BTUs;
_..... Location(s):—,,,,.._ �....�
Other:__
—
BTUs: eee„
�... m Location(s), ........_,��._....._.-...... -_...
Fireplace/Insert
__
BTUs:
�._. _ Location(s):
Stove/Range/Oven
Dryer
Outdoor B�
BQ
TOTAL OUTLETS
FORM C 1-Muilding New Folder 2010\130NE & x-(erred to GBuilding-New drive\Form C 2014.docx Updated: 1/17/2014