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BLD20170064.pdf0 UITY OF EDMONDS 1215TH AVENUE NORTH -EDMONDS, WA 98020 PHONE: (425) 771-0220 = FAX: (425) 771-0221 STATUS: APPLIED 01/13/2017 ������ � MINE � � . ��� �J�,�1 '' l WKS, �# 1 „ Expiration Date: 07/13/2017 �� �� '� � �� 9 � . Ol l , u a��r +� r ���, e . m tb� r� n, ,n., u Parcel No: 00450700500013 BAHRAM SAMANIAN 22425 100TH AVE W EDMONDS, WA 98020 , (425)678-8262 1JA111\A1Y1 UA1YlA1`IlAlY V VY 1`I Ll� liALIVII 11V3`I 22425 100TH AVE W C/O BAHRAM SAMANIAN EDMONDS, WA 98020 22425 100TH AVE W EDMONDS, WA 98020 (425)678-8262 (425)678-8262 11N3UL,A lit'. A1NLJ.L)IC T W ALL t5A3=VlrIN 1 . 1 nAINUC UUi1 W 11NULM D. ALL WORK SUBJECT TO FIELD INSPECTION VALUATION: $3,000.00 PERMIT TYPE: Residential PERMIT 'GROUP: 04 - Alteration/Remodel GRADING: N CYDS:-0 TYPE OF CONSTRUCTION, RETAININGWALLROCKERY: OCCUPANT GROUP OCCUPANT LOAD: FENCE: ( 0 X 0 sFT .I OTHER. ------- OTHERDESC: CODE: 2015 ZONE: NUMBER OF STORIES: 0 NUM13litt OF DWELLING UNITS: 0 BASEMENT:0 1ST FLOOR: 0 2ND FLOOR: 0 VESTED DATE: LOT #: BASEMENT; 0 1ST FLOOR: 0 2ND FLOOR: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 BEDROOMS:0 BATHROOMS: O 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 BEDROOMS: 0 BATHROOMS O 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 RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, THIS APPI "N"105? , IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID, � SP1 ? �; o/ / /7 igna a Print Name Date I Released 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, UBCI 09/ IBC110/ IRCI 10, ONLINE APPLICANT = ASSESSOR OTBER STATUS: APPLIED 7 • 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 alternatedesign, 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 from temporary, construction sites as a result of construction activity are exempt from the noise limits ofECC Chapter 5.30 only during the hours of 7:00amto 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 ofhis 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 ofthis 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. 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) PUBLIC WORKS ? 771-0235 PRE•TRE,ATNIFNT (Wj 672-5755 RECYCLING 425 ,275-4801 • B-Preconstructionmeeting • B -Window Flashing • B-Insulation/Energy • B -Building Final t 1" P 19 1 � �w ljlDEVEIIN Mi T SERVICES PLUMBING, MECHANICAL, TANK, & DEMOLITION PERMIT APPLICATION 121 5`h Avenue N, Edmonds, WA 98020 Phone 425.771.0220 A Fax 425.771.0221 City of Edmonds PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street,,Suite #, City State, Zip): 180?o Parcel #: / 5 % _)OM A/ i� l"> C'd,0a /JI%5 w4 -- 4 - IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No IS APPLICANT: Phone: Fax: Address (Street, City, State, Zi ): J gO I j V\, -A ;_Mail Address: � C � 10 y eW ,tea. OWNER: PROPERTY OW Phone: Fax: � � N / � V Address (Street, City, State, Zip): E -Mail Address: 5I ©o ems,_ ory t— kErG AGENCY: Phone: Fax: 2tss (Street, City, State, Zip): E -Mail Address: CON RA TOR: l� .� 01 Phone: Fax: Address (Street, City, State, Zip): I E -Mail Address: 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 MECHANICAL TANK DEMOLITION j DETAIL THE SCOPE OF WORK �u� ._ .: ". _fes ........r� 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:- t ` I 'A^ Owner �Agent/Other ❑ (specify): • Signature: �°� Si Date: g � . FORM C LABuilding New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.doex Updated: 1/17/2014 EXEMPTION FROM CONTRACTOR REGISTRATION VERIFICATION FORM D The undersigned property owner or authorized person as described below, has applied for a building permit from the City of Edmonds and claims that he/she/it is exempt from providing contractor registration in accordance with the provisions of RCW 18.27. The property owner or authorized person, by their signature below, hereby verifies to the City of Edmonds that: ❑ Value of work under $500.00. The aggregate contract price of labor and materials and all other items required for the project is less than $500.00 and is not part of a larger operation to be tinderu en on the property, This exemption does not apply to a person who advertises or puts out any sign or card or other device which might indicate to the public that he/she is a contractor, or that he/she is qualified to engage in the business of contractor. RCW 18.27.090(9). ❑ Owner who contracts for a project. A property owner contracting with registered contractors for the project, and who him/herself is not performing any activity of a contractor for the purpose of leasing or selling improved property that he/she has owned for less than twelve months. RCW 18.27.090(11). "'°ork performed personally on own. property. Anyone personally working on property he/she owns, or at which he/she resides, as long as the property owner, or resident, does not perforin any activity of a contractor on his/Mer property for the purpose of selling, demolishing, or leasing the property. RC's/ 18.27.090(12). ❑ Use of own employees. Property owner using him/herself or his/her own employees to perform maintenance, repair, and. alteration work in or upon his/her own property. RCW 18.27.090(13). ❑ Licensed Architect, engineer, electrician or plumber. All work performed under this permit will be performed by an architect, civil or professional engineer, certified electrician or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14). 0 Other. Specify which provision of RCW 18.27.090 applies: THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED. 20". DATED this � � day ot'a . � � , PROPS . O" NE AUTHORIZED PERSON \ed� Signature Print Name WITNESS A Signator Print Name L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM D.DOCREVISED 7/07