0314_001.pdfO 1- L U 4!
CITY OF EDMONDS
121 5TH AVENUE NORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 02/22/2019 Pennit#: BLD20190191
BUILDING PERMIT
F;pirationDate: 02/22/2020 P:•uject:;;!:1:;s�:: ��2? 220'!'1i cT 5� , EDMONDS
Parcel No: 00461000201901
ZACH COOPER
ADDED VALUE HOME
ADDED VALUE HOME IMPROVEMENTS
7623 220TH SW
IMPROVEMENTS.
C/O MATTHEW MAT YSIK
EDMONDS, WA 98026
C/O MATTHEW MATYSIK
20404 88TH AVE W
20404 88TH AVE W
EDMONDS, WA 98026
EDMONDS, WA 98026
(206) 402-1711
(206) 819-2809
(206) 819-2809
LICENSE #: ADDEDVH833N4 EXP-08/24/2019
LIKE FOR LIKE BEAM REPLACEMENT. OK PER CHUCK MILLER TO ISSUE W ITHOUT PLANS, AND OVER THE COUNTER.
VALUATION: $2,000
PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alteration/Remodel
GRADING: N CYDS: 0
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:0 187 FLOOR:0 2NDFLOOR: 0
BASEMENT:0 1ST FLOOR:0 2NDFLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS:0 BATHROOMS:O
1 BEDROOMS:0 BATHROOMS:0
REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZ-ED 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 NQTA PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL 0941IS/HER DEPWAND ALL FEES ARE PAID.
IN% s2 p4 / `T
`signature Print Name ate Released By Date
ATTENTION
Zu-,SUNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCI 09/ IBC110/ IRC110.
FIRE APPLICANT ASSESSOR ITY
"? C. 18`)"
BUILDING PERMIT
APPLICATION
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: http://www.edmondswa.pov/
JOB SITE INFORMATION/LOCATION: (Where theworkis taking place)
Job Site Address: 6Z) zzoyyn
Farc��
Lot /Unit/Suite #: Suub-a Un-�
PROPERTY OWNER:
Name: % c.C�, C,,r,Lvr
Mailing Address: 76 Z3 -Z-ZD'tN- C�- Svc ly
City/State/Zip: f—�d MCPJI; VJ, $O a
Phone #: (?if-') 14C r2_ 70
Email: % r C. Ju %>t' r ' V Syv ,-
OWNER INSTALLATION: *If yes, read and sign*
Will work-be-rLhe property owner? ❑ Yes l�No
I own, resireside in the completed structure.
This installg made on property that I own which is
not intendease, rent, or exchange according to
RCW 18.27— --- - -- — — —�
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Permit #:
❑ Accessory Structure/
El Addition
Detached Garage
❑ Demolition I ❑ Mechanical
❑ New Single Family / Duplex I ❑ Plumbing
❑ Fire Sprinkler I ❑ Remodel
❑ New Commercial/ Mixed Use ❑ Re -Roof
❑ Signs ❑Tank
❑ Tenant Improvement EPOther Pesm,�
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: CZ) d
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Name of Applicant: M 1,ovl tr� •-� S. �� Other sq ft:
Mailing Address: 70H01-1 '9114— Nye
City/Stat /Zip: )ad Nw A Vj H &Dig
Phone C� ��%�
E-mail: G1�Oe �� �U� Y�orn� i mn r�J�f�►erft', ld Iry
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
lei D VIA 8 3.N)14
CITY OF EDMONDS BUSINESS LICENSE #:
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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: 1�d1 M nA
Signature: