BLD20150409.PDFv
J
COMPLETED
of F MD'1�
CITY OF EDMONDS
lac•. I R90
STATUS: ISSUED 04/01/2015
Expiration Date: 10/01/2015
Parcel No: P488800201408
PROPERTY ONNINER
MICHAEL HELDE
23117 75TH PL W
EDMONDS, WA 98026
(206)601-3521
2 GAS OUTLETS FOR BBQ AND STOVE.
VALUATION: $0.00
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Project_ Address_23117 "75'T, YL
HEAT FLOW MECHANICAL LLC
24231 23Rd Ave Se
Bothell, WA 98021
(425)354-0575
R D20150409'
HEAT FLOW MECHANICAL LLC
24231 23Rd Ave Se
Bothell, WA 98021
(425)354-0575
LICENSE N: HEATFFM8990R EXP:10/16/2015
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:
OTHER: ------- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT 4:
loll
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. IREQUIRED. PROPOSED: IREQUIRED. PROPOSED.
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OFT HE LABOR CODE OFT HE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
r Z ,/
_'� , �Z� //G Wt
1 Print Name Date FZbleased By 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/ IBCI 10/ IRCI 10.
= ONLINE = APPLICANT = ASSESSOR OTHER V61
STATUS: ISSUED
BLD20150409
• Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
• 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 altemate 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.
• 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 fromthe noise limits
of ECC Chapter 5.30 only during the hours of7:00amto 6:00pmon weekdays and 10:00amand 6:00pmon 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 from the issuance for this permit. Issuance of this pemlit 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 (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720
PUBLIC WORKS 425) 771-0235 1 PRE-TREATMENT (425) 672-5755 1 RECYCLING (425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Prefereed, and %nether you prefer morning or afternoon.
• B-Gas Test/Pipe
• B-Plumbing Final
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
�St 1 g9� Phone 425.771.0220 Q 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 #:
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: r/
Phone:
Fax:
Address (Str et, City, State, Zip : &Z L$
E-Mail Address:
PROPERTY OWNER: /
Phone:
Fax:
���
2�• fool , 35��
Address (Street, City, State, Zip):
a I
E-Mail Address -
.eG� I t' 4.1, ,4-,
LENDING AGENCY:
Phone:
Fax:
Ad ss (Street, City, State, Zip):.
E-Mail Address:
CONTRACTOR:*
4.i k ot, GG U--�
Phone:
5 -:;�G4 c--c ?5
Fax:
Address (Streets City, State, Zip):
�4o1C3( ' S
E-M it Address:
t
co��✓ a�
VA; a_54(!9.,A:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to doing work
q"-r F FiLt$WOT,>
in the City. Contact the City Clerk's Ojjice at 425. 775.2525
City BBusinesLicense #/Exp. Date:
PEP-MITAi. . ..
PLUMBING MECHANICAL TANKI
I DEMOLITION Lj
I
DETAIL THE SCOPE OF WORK: Z
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 properly owner or duly authorized agent of the property owner to submit a permit application to the Cily of
Edmonds.
,/�
Print Name: LkV a/ *4140S Owner Agent/Other ❑ (specify):
Signature: /`^ Date:/(/(!5
k
k
k
k
FORM C L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014
PLUMBING
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/Shower
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e.g. RSPA, 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:
MECHANICAL
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #—Elec
#—Other:
#_ BTUs: <100k >100k
Location(s)
Air Handler / VAV
Gas #
Elec #
Other:
#_CFM: <10k >10k
Location(s)
(circle selected)
—
—
—
AC / Compressor /
Boiler / Heat Pump /
Gas #—Elec
#_Other:
# BTUs: <100k,
100k-500k, 500k-IMil
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 #
#_
duct)
_Other:
Fireplace
Gas #
Elec #_Other:
#_ Location(s)
Dryer Duct
i
L
FUEL GAS
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs: Location(s):
Furnace
BTUs: Location(s):
Water Heater
BTUs: Location(s):
Boiler
BTUs: Location(s):
Other:
BTUs: Location(s):
Fireplace/Insert
BTUs: Location(s):
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
Z
FORM C L:\Building New Folder 2010\DONE & x-(erred to L-Building-New drivelForm C 2014.docx Updated: 1/17/2014