BLD20170905-APPROVED PERMIT.pdf`;'/%;moi%CITYOF
EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
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STATUS: afPl�("1�f4�-
ISSUED 07/03/2017
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Expiration Date: 01/03/2018'
C 1
Parcel No: 00423000002900
PRO-PERTY OWNER
APPLICANT
NANCY DAVIDSON
----CONTRACTOR
NANCY DAVIDSON BEACON PLUMBING& MECHANICAL
1 1 1 1 EMERALD HILLS DR
1'1 1 1 EMERALD HILLS DR C/O WILLIAM CAHILL
EDMONDS, WA 98020
EDMONDS, WA 98020 8611 S 192ND ST-
KENT, WA 98031-
(425)771-5329
(425)771-5329 (800)373-2546
LICENSE # BEACOPM956KS EXP 05/20/2019
JOB DESCRIPTION
Repaired leak in water fine.
VALUATION: $0.00'
PERMIT TYPE. Residential
PERMIT GROUP: 47 - Plumbing
GRADING N CYDS:O
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY
OCCUPANT GROUP
OCCUPANT LOAD
FENCE ( 0 X 0 'FT)
CODE
OTHER: -------OTHERDESC
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:
DECK: 0 OTHER: 0 13RD FLOOR 0 GARAGE 0 DECK 0 OTHER:;0
,O
BEDROOMS:0 BATHROOMS:0
BEDROOMS:0 BATHROOMS:0
FRONTSErBACK
SIDESETBACK,
REQUIRED: PROPOSED
REOUIRED; PROPOSED;i REQUIRED PROPOSED;
HEIGHT ALLOWED.O PROPOSED
0: REQUIRED: PROPOSED;
SETBACK NOTES:
PERMITAPPROVAL
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,
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID,
w
L4 Z017
ignad Print Name Iia Release"y 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/ IBCI 10/ IRC110
ONLINE
APPLICANT ASSESSOR OTHER
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
IyS 1�1' 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): Parcel #:
Z----P"Ir,4d mi //,s 'D
_2 4 , �P , TIP 190 Associated Permit #:
IS THIS WORK ASSOCIATED WI"I°II ANOTUR PROJECT? Yes ❑ No
APPLICANT:Phone: Fax:
GLIA' i afs0Y) -771-
Address (Street, City, State, p): y)Ary�D Y� 0(�jd5 Dn P I AJ
PROPERTY OWNER: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
CONTRACTOR:* , Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
i
WA State License #/Exp. Date:
*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 City Business License #/Exp. Date:
PLUMBING j MECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK: _ j ..._ _� .. .... J._ LL ....
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 ' �� �.— Owner Agent/Other ❑ (specify): Nw.._._..____.....
Signature: W �..�_
FORM C LABuilding New Folder 2010\DONE & x-ferred to L Building -New driveTonn C 2014.doex Updated: 1/17/2014
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PLUMBING
Fixture Type (new and relocated)
Total #
FIXTURE
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
�.......�w..........
........
Pressure Reduction Valve/Pressure Regulator
.. _.__,,._ _...._ _, � ....._
... ...._ �.._......�®
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
I
Tub/Shower
Drinking Fountain
Dishwasher
_
Clothes Washer
._ .
... .w ............. _...........
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:
LI
Refrigerator water supply (for w ater/ice dispenser)
Other:
FORMIC LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014