0075_001.pdf0 I n,, BUILDING PERMIT
(J1' APPLICATION
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Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: litto://www.edmondswa.gov/
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: �i 1V0! �h�7c/7Ar► �^ ti
Parcel:
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: IVNI /Y &—e.
Mailing Address: AV
City/State/Zip:
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes ❑ No
own, reside in, or will reside in the completed structure.
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: / %�i +r-e.A
•
Mailing Address: Z D .2-5 S 151VA o.SA
City/State/Zip:.54ft a b✓9o4— % iS9
Phone #: ,�d .C,�� J Z
E-mail
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
CITY OF EDMONDS BUSINESS LICENSE #:
-Mice IJse Oi uy
TYPE OF
❑ Accessory Structure/
Detached Garage
Details on Page
❑ Addition
❑ Demolition
❑ Mechanical
❑ New Single Family / Duplex
P mbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
❑ Tank
❑ Tenant Improvement
❑ Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT•
I certify 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: a
Signature: Date/
r%_
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GENERAL
. DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes ❑ No ❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE .. .. .
Qty Qty
Clothes Washer Tub/ Showers
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain Pressure Reduction/ Regulator Valve
Floor Drain/Sink Refrigerator Water Supply
Hose Bibs Water Heater - Tankless? Y or N
Hydronic Heat Water Service Line (yys
Sinks Other:
Toilets Other:
CONNECTION • .. .. .
BTUs City BTUs City
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL.
Relocated. re -piped)
Qty
Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
:DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material:
Removal ❑ Size of Tank (Gallons)
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
•.DEXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.
'nC. 1 R1)"-'
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 01/22/2019 Permit #: BLD20190067
BUILDtNG
Expiration Date: 07/22/2019 Project Address: 880 NORTHSTREAM LN, EDMONDS
Parcel No: 00532500001900
PROPER-[A'O'"NM APPLICANT CONTRACTOR
RONALD M & NANCYANNE MOORE PRICOR TECHNOLOGIES PRICOR TECHNOLOGIES
880 NORTHSTREAM LN 2825 S 154TH ST 2825 S 154TH ST
EDMONDS, WA 98020-2636 SEATTLE, WA 98188 SEATTLE, WA 98188
(206) 258-5270 (206) 258-5270
LICENSE #: NR-020649 EXP:
C DESCRIPTION
REPAIR WATER LINE BY THE METER
VALUATION: $0
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
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
LOT #:
,O ,
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
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 QR HIS/HER DEPUTY AND ALL FEES ARE PAID.
Signature Print Name Date Released By
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/ IBC110/ IRC110.
a FIRE = APPLICANT = ASSESSOR CITY
STATUS: ISSUED BLD20190067
CONDITIONS
• City approved plastic piping may be used in water service piping provided that where metal water service piping is used for
electrical grounding purposes, replacement piping shall be of like materials (UPC 604.8). A state electrical permit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of Labor &
Industries Electrical Division at 425-290-1400.
• 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 alternate 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 of 7:00am to 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 of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmles s the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance for this permit. Issuance of this 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.
• Owner/Contractor to provide Water Service Line asbuilt at final inspection. See City Standards for requirements.
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
1. Go to: www.edmondswa.gov
2. Then: Services
3. Then: Permits/Development
4. Then: Online Permit Info
5: If you don't have one already, create a
login (upper right hand comer)
6: Schedule your inspection
ENGINEERING (425) 771-0220 EXT. 1326
Building Department Inspections
are now scheduled online. If you FIRE (425) 775-7720
have difficulties, please call the
Building Department front desk for I PUBLIC WORKS (425) 771-0235
assistance during office hours.
(425) 771-0220
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 Preferred, and whether you prefer morning or afternoon.
E-Water Service Line