1427_001.pdfOI. E UM
y `''� CITY OF EDMONDS
1215TH AVENUE NORTH - EDMONDS, WA 98020
o PHONE: (425) 771-0220 - FAX: (425) 771-0221
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STATUS: ISSUED 06/14/2019 Pennit 71: BLD20190720
WILDING PERMIT
Expiration Date: 12/11/2019 I'viiject Addi-e s: 22606 18'1'11 AVE XV, EDMONDS
Parcel No: 00450700700001
PROPERINOWNER APPLICANT CONTRACTOR
DANIELLE & LUCAS-SMITH PH FINNEY ADDICOTT ROOFING ADDICOTT ROOFING
22606 98TH AVE W C/O RODNEY ADDICOTT C/O RODNEY ADDICOTT
EDMONDS, WA 98020-5908 18926 83RD AVE W 18926 83RD AVE W
(425) 672-3431
R&ROOF
VALUATION: $0
EDMONDS, WA 98026 EDMONDS, WA 98026
(425)774-0806 (425)774-0806
LICENSE #: ADDICI*219JT EXP:05/10/2020
PERMIT TYPE: Residential
PERMIT GROUP: 54 - Re-Roof/Roof Alter/Repair
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 1STFLOOR: 0 2NDFLOOR: 0
BASEMENT:0 1STFLOOR: 0 2NDFLOOR: 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
REQUIRED: PROPOSED REQUIRED: PROPOSED: REQUIRED: PROPOSED
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
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 Q9;10� ALL FPS ARE PAID.
p60n %e- k\C 1� t1y t %A Q) ' l
Print Name Date
By
I
Date
ATTENTION
IT IS 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.
FIRE = APPLICANT = ASSESSOR CITY
STATUS: ISSUED
BLD20190720
• 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 from temporary construction sites as a result of construction activity are exempt from the 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
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 of this permit shall not be deemed to
modify, waive or reduce any requ remenis 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 FUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SE'ARA IE PLRMISSION, 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
Building Department Inspections
are now scheduled online. If you
have difficulties, please call the
Building Department front desk for
assistance during office hours.
(425) 771-0220
ENGINEERING (425) 771-0220 EXT. 1326
FIRE (425) 775-7720
PUBLIC WORKS (425) 771-0235
RECYCLING (425) 275-4801
When calling for an inspection please leave the followng 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.
• B-Roof Tear Off
• B-Building Final
"c. i s,)
BUILDING PERMIT •
APPLICATION 7P.r-mit#: �/v/r-0'��
Development Services 4���////llll���LLVV�� I
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.eov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, Large Additions, ADU's, New Commercial, and Major Tenant
Improvement application submittals. If plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please call425-771-0220 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 0i(0d(O R?P2 e
Parcel: WAboa( p+0000
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: _K:>6Nc1'NP\VP ;Pi c\re`P �h.r.OLIIC S`
Mailing Address:QQ(00(0 clfb`t Age U—)
City/State/Zip: F-(NyyNLp" & > UJ A 01 C 0
Phone#: 2� -l_9J1.2 • -ii—y `3
Email: (�,i 'T v1�C1 2�1 ct� `u'c`r�c�� �• orv�
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes '54No
I 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: fcii5`r)"fA�f
Mailing Address: 2Z11,00 (D C;yb` 4�0C V'_')
City/State/Zip: E �`MUv� a.S 1 LA.) Pt C W 2-(
Phone #: v�c'J - �D� Z ' ?_11 i '_�)
E-mail: ��- r�v�eV1 0� VNCh YYy0.k \ . Lor",
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address: \5ol2.l0 - $ JflIvC- U-)
City/State/Zip: mo+nr�S , WIN CRIDI(a• (oQ\_}
Phone#: ��-�J•—jly •()t CO
E-mail: Y 06 na 0.c\[\ � Cv� � roo�', Ana • C_O•M
STATE UBI #: (R 00 2—A � I (0 I
CITY OF EDMONDS BUSINESS LICENSE #: St-OaLA 21
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
ZC(o(oF)Lo00 02-(2-02.0 MA��Wtil1(il►
TYPE OF
Details
❑ Accessory Structure/
❑ Addition
Detached Garage
❑ Demolition
❑ Mechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
>1Re-RoofO +�
❑ 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, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT•
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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.
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Print Name: `)li,`n,,e_��e 2- �T srn" e �e
Signature` LNCs\ &k !0Date
COMMERCIALGENERAL 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
EQUIPMENTMECHANICAL • .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
Sinks
Other:
Toilets
Other:
CONNECTION COUNTS.. .. .
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL•
.. ..
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 ❑
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERALPROVISIONS
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.