20170803125733.pdfOX.- EI)4f
CITY OF EDMONDS
PHONE: (425) 771-0220 - FAX: (425) 771-0221
121 5TH AVENUE NORTH - EDMONDS, WA 98020
STATUS: ISSUED 08/03/2017
Expiration Date: 02/05/2018
Parcel No: 00477300001001
SHARON NICHOLS
17624 TALBOT RD
EDMONDS, WA 98020
Replace waters ervice line.
VALUATION: $0.00
FULLBOREINC
C/O CESAR LARA
1546 NW 56TH ST
SEATTLE, WA 98107
(206) 259-0415
Pomiif I-h BLD20171069
FULLBOREINC
C/O CESAR LARA
1546 NW 56TH ST
SEATTLE, WA 98107
(206) 259-0415
LICENSE #: FULLBB1954DI
EXP:04/30/2019
PERMIT TYPE: Residential
PERMIT GROUP� 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: OXO FT)
CODE:
OTHER: ------- OTHER DESC:
IZONE:
NUMBER OF STORIES: 0
VESTED DATE.
NUMBER OF DWELLING UNITS: 0
LOT #
BASEMENT-0 I ST FLOOR: 0 2ND FLOOR 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK:O OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK:O OTHER 0
,BEDROOMS: 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
nIONTSETRACK SIDESETBA('k REA11SETBACK
�EQUIRED: PROPOSED: 117EQUIRED: PROPOSED: rR-E —QU I RE D: PROPOSED:
MIGHT ALLOWED:O PROPOSED:O IREQUIRED PROPOSED:
)ETBACK NOTES:
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.
TI lKA'hP'M.CA-ON IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISIHER DEPUTY AND ALL FEES ARE PAID.
e�7ci ( Lci A'U��v ()ezz'd- OeIO312-017
n'Au re Print Name Date Released 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/ IBC1 10/ TRCI 10.
ONLWE E2fAPPLICANT ASSESSOR [2romm
STATUS: ISSUED BLD20171069
IINMT�
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron laniphole cover is required at the property line.
• Maintain 10'separation between the sanitary side sewer and the water service line.
• A separate right-of-way construction pen -nit is required for work within the City right-of-way.
• Condition of the existing lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.
• Condition of the eidsting sanitary side sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
• Easement and/or permission from adjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Owner/Contractor to provide Side Sewer as built at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise firnits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00pmon Saturdays, excluding
Sundays and Federal Holidays. At all othertimes 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 ofthis permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not 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 CONSTRUCT10N ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT T1ME LIMIT: SEE ECDC 19.00.005(A)(6)
I BUILDING (425) 771-0220 E)Cr. 1.333 1 FNGINFIMING (4251771-0220 EXT. 1326 1 FIRE (425) 775-7720 1
I PUBUC WORKS (425) 771-0235 1 PRFTREATMENT (425) 672-5755 1 RFJCYCLlNG (425) ��
When calling for an inspection please leave the folloAng information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Prefereed. and mbether you prefer morning or afternoon.
0 E-Water Service Line
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
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
moy\v
Parcel #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No�J
Associated Permit
et\j (:1 17
APPLICANT:
Fax:
Address (Street, City, State, Zip):
Is �/c N yu 5� k
E-Mail AddrcT
uAofeTfievic'We�
PROPERTY OWNER: C, vo)_�
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR: * �j \\ �)Of
Phone: F
ax:
Add (S
t, city ta Z'V�
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
WA State License #/Exp. Date:
City ncss Lic e:
I 32-0t94`t;
PLUMBING MECHANICA TANKI
I DEMOLITION
DETAIL THE SCOPE OF WORK: 76
6o(-r V\), �N -till V 0_;�
NO
I declare under penalty ofperjury laws that the information I have provided on this formlapplication 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.
Own ther EX(specify,.
Print Name: C C-) er [:1 Agent/O
Signature: Date:
�� crd-;�,
FORMC LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.doex Updated: 1/17/2014
PLUMBING
Fixture Type (new and relocated) Total #
FIXTURE' COUNT
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
Hose Bib
Backflow Prevention Device (�.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes 0 No
Hydronic Heat in: Floor Ej 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 Handier / VAV
(circle selected)
Gas #—Elec
#—Other:--
# CFM: <10k— >10k—
Location(s)
AC / Compressor
Boiler / Heat Pump
Roof Top Unit
(circle selected)
Gas #—Elec
HP:
#—Other:—
_<3,-3-15,_15-30
#_ BTUs:—<100k,
Location(s)
100k-500k, 500k-1MiI
Hydronic Heating
Gas #—Elec
#—In-Floor
—Wall Radiant— Boiler BTUs:
1,0catioll
Exhaust Fans (single
duct)
Bath #
Kitchen # Laundry # —Other:
Fireplace
Gas #—Elec
#—Other:—
#_ l,ocation(s)
[Dryer Duct
lvjm��
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
Furnace
BTUs: Localion(s):_
BTUs: Location(s):_
Water Heater
BTUs: Location(s):_
Boiler
BTUs: Location(s):_
Other:
Fireplace/Insert
BTUs: Location(s):_
BTUs: Location(s):-
Stove/Range/Oven
Dryer
BBQ
IOutdoor
I TOTAL OUTLETS
FORM C LABuilding New Folder 201 O\DONE & x-ferred to LBuilding-New driveTorm C 2014.docx Updated: 1/17/2014