20170217122123.pdf0,
k-ITY
OF EDMONDS
121 5TH AVENUE NORTH -EDMONDS, WA98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 02/16/2017
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Expiration Date:08/16/2017
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Parcel No: 00463302800500
PRoPrjz,ryOwNER
PATTY PAULSEN
APPLICANT CONTRACTOR
PATTY PAULSEN FISCHER PLUMBING CO INC, THE
24209 92ND AVE W
24209 92ND AVE W C/O BRUCE ROBERTSON
EDMONDS, WA 98020-6503
EDMONDS, WA 98020-6503 6608 220TH STREET SW
MOUNTLAKE TERRACE, WA 98043
(206)786-7211
(206) 786-7211 (206)783-4129
LICENSE#: FISCHPC131RI EXP:02/22/2018
TRENCHLESS REPLACEMENT OF WATER LINE FROM SHUT OFF TO METER.
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: 2015
OTHER: ------- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF 17W 6 L[,111C1 UNITS: O
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:
PERMIT APPROVAL
1 Al11Il:I: TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
TN 1C 1: °, 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.,
TI,ilS '-1:,1 ",A T"11" '; NOT A aLRM1'1" UNTIL Sl( � BY THE BUILDING OFFICIAL OR 111M IRDEPUTY AND ALL FEES ARE PAID
Ak
Signature Print Name
Date Rel aced By Date
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/ IBC110/ IRC110.
ONLINE APPLICANT ASSESSOR OTHER �•
TTTC. TC'C7TT'i %
32
• Pursuant to UPC 605.2 a water service shutoff shall be installed on the waterline as it enters the building.
• 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.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") 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 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 7:00am 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 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 fi•omthe issuance for this pennit.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.
• Refer to, City of Edmonds Water service line handout for approved pipe materials, inspections and other requirements.
• Owner/Contractor to provide Water Service Line as built at final inspection. See City Standards for requirements.
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)
E.Water Service Line
ul
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City of Edmonds
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 ft Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
f0
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
St:,
D. A
(StrM, City„ State, Zip).:.
LL:1V ll11�4 (i"U Y
Address (Street, City, State, Zip):
CON ACT)R:*
A4 dress S. cc(, City„ Stat Zip
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Phone: I _ . , 11 Fax:
is -Mail A 1ress..
hone' Fax.
E-Mail Address:
Phone: 11 Fax:
E-Mail Address:
Phone: Fax:
el frowl E-Mail Address:.
*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
PLUMBING
DETAIL THE SCOPE OF WORK:
`Tv4u-<)�
MECHANICAL 11 _I TANK
I
3
WA State License #/Exp. Date:
City Business License #/Exp. Date:
DEMOLITION
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. /
Owner
Print Name: ..:..1� .....(specify):m �.w......_........
❑ Agent/Other 0 t Date:
Signature:_....: ..�:. ...�.�_ �
FORM C L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014