BLD2021-0549_Supplementals_4.15.2021_1.54.27_PM_2147833. OF FD,y
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MyBuildingPermit.com
Jurisdiction: Edmonds
Project Name: 927674
Application ID: 950258
Supplemental Name: Authorization Statement - Plumbing
All provisions of laws and ordinances governing this type of work will be complied with. I certify under penalty of perjury that the
information provided on this application is true and correct and, further that I am authorized by the owner of the above premises to
perform the work for which the permit application is made. I further agree to hold harmless the City of Edmonds as to any claim
(including costs, expenses, and attorney's fees incurred in investigation and defense of such claim), which may be made by any
person, including the undersigned, and filed against the City of Edmonds, but only where such claim arises out of the reliance of the
City, including its officers and employees, upon the accuracy of the information supplied to the City as part of this application.
I hereby authorize the City representatives to inspect my property Monday -Friday between the hours of 8:00 a.m. and 5:00 p.m.
during this permit application process for verifying site conditions.
Yes
Supplemental Name: Electronic Submittals - Plumbing
Electronic documents submitted to the City of Edmonds for plan review and permit issuance must be provided in a format that does
not prevent the City from making code comments on the documents during review or from making the documents ready for permit
issuance. Documents submitted in any manner that prevents the City from completing the review and permit issuance process,
including but not limited to submitting documents that are locked, may result in additional review time, permitting delays, and/or
cancellation of the permit application if the problem is not resolved by the applicant in a timely manner.
Please refer to chapter 18.43 RCW, chapter 18.210 RCW, chapter 196-23 WAC and chapter 196-33 WAC for Washington State laws
governing electronic documents. An interpretative guideline from the Board of Registration for Professional Engineers and Land
Surveyors can be found at http://www.dol.wa.gov/business/engineersiandsurveyors/docs/eDocsinterpretiveGuideline.pdf. These
laws and requirements are subject to change and the submitting parties are responsible for keeping apprised of any such changes.
Please acknowledge that you understand these requirements and have verified the electronic documents being submitted meet the
City of Edmonds submittal requirements by checking the box below. If you have questions, contact permit processing
at onlinepermits@edmondswa.gov or 425-771-0220.
Yes, I acknowledge.
Supplemental Name: Plumbing Fixture Counts
Enter the number of plumbing fixtures being installed, altered, repaired, added or relocated:
Water Heater(s). ENTER QTY and specify GAS or ELECTRIC
1 Electric Water Heater
Plumbing fixture(s) on one trap or set of fixtures on one trap - Includes sinks, toilets, tubs, showers, etc. ENTER CITY
Drain(s) w/in footprint of building (rainwater systems, roof deck drains, etc.) ENTER QTY
Re -pipe. Drain(s), vent(s) or water piping for each fixture served. ENTER QTY
Water service line(s) - replacement or repair only. ENTER QTY
Water service line(s) - New only. ENTER QTY
Water treating equipment (water softener). ENTER QTY
Backflow protective device(s) - 2" and smaller. ENTER QTY
Backflow protective device(s) - Over 2". ENTER QTY
Graywater system(s) or reclaimed water system(s) in addition to fixtures. ENTER QTY
Non -grease waste pre-treatment interceptor(s) - Oil/water separator. ENTER QTY
Medical gas piping system(s). ENTER QTY
Grease trap(s) - HGI inside building. ENTER QTY
Gravity grease interceptor(s) - GGL ENTER QTY