1469_001.pdfCITY OF E,DMONIDS
12I 5TH AVENUENORTH - EDMONDS, V/A 98020
PHONE: (42s)77l-0220 - FAX: (AÐ771-0nt
c. l8
STATUS: APPLIED
Expiration I)ate : 12 /19 /2019
Parcel No: 00561 100000600
I il,ri ¡ ¡ r i í ir,; : | [iII i,l lD:¿i0lii i9i Ð''i I /4l;'];,
BI]ILDIN(ì PBIIMIT
PR( ) l' Fl,R'l-\' ()WN F.Il {PPLI( ANT C]ONTRA('1'OII
KARA AND FORREST WEDMORE
2t523 86TH AVE W
EDMONDS, WA 98026-7307
(42s) 346-0477
PUGET SOTJND GASWORKS
C/O NEAL MARKLEY
23 I7 TWIN PL
ANACORTES, WA 98221
(42s) 346-0477
PUGET SOUND GASWORKS
C/O NEAL MARKLEY
2317 TWIN PL
ANACORTES,WA 98221
(42s) 346-0477
LICENSE #: PUGETSGS5IN6 EXP:08/2612019
.l()lì DLscRlP'l-loN
GAS PIPINGFROM METER TO HOUSE
VALUATION: S0
PERMIT TYPE: Residential PERMIT GROUP:47 - Plumbing
GRADING: N CYDS: O TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY:OCCUPANT GROUP
OCCUPANT LOAD:
FENCE: ( 0X0 FT.)CODE:
OTHER: ----- OTHERDESC:ZONE:
NUMBER OF STORIES: O VESTED DATE:
NUMBER OF DWELLINGUNITS: O
2ND FLOOR: 0BASEMENT: O IST FLOOR:0 1ST FLOOR: 0 2ND FLOOR: 0
LOT #
BASEMENT:O
3RD FLOOR:0 GARAGE:0 DECK:0 OTHER:0 3RDFLOOR:0 GARAGE:0 DECK:0 OTHER:0
BEDROOMS:0 BATHROOMS:0 BEDROOMS:0 BATHROOMS:0
t,t\ls t't\(, \R¡:{l'lì.() l'() S l'll) ¡\l{l-A
REQUIRED: PROPOSED:REQUIRED: PROPOSED REQUIRED: PROPOSED
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED
SETBACK NOTES:
F|Ì()NI's gl"BAc-I(S IDES ETIìA(.K IIF]AI{ SFTBACK
IAGREE TO COMPLY WTH CTTY AND STATE LAWS REGULATNG CONSTRUCTION AND IN DOING THEWORK AUTHORZEÐ THEREBY, NO
FERSON WLL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RB.ATNG TO WORKMEN'S COMFENSATION
INSURANCE AND RCW 1 8:27.
A FERMT UNTIL SIGNED BY THE BUILDING OFFICAL OR HIS/HER DERJTY AND ALL FEES ARE PAID,ISTHIS
PERM]T APPROVAL
2Q/rà4 rt/núo*6t19119
Nann Released By
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING ORSTRUCruRE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCI09/ IBCI IO/ IRCI IO.
FIRE APPLICANT ASSESSOR CITY
coNDtï'loNS
STATUS: APPLIED 8LD20190743
o C¿s pipe test nn¡st be observed by City Building Inspector, afüdavits shall not be accepted.. Final approval on a project or f,nal occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. CÏreckthe job card for all required Cþ inspections including final project approval and final
occupancy inspections.
. Any request for altetnate design, modification, variance or other administrative deviation (hereinafter "variance") f,om
adopted codes, ordinances or policies must be specificalþ requested in wriling and be called out and identified. Processing
. ".t
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 coÍply with cþ code and for which a variance has not been
specificalþ identified, requested and considered by the appropriate city offìcial in accordance with the appropriate provision
ofcity code or state law does not approve any items not to code specification.. Sound/Noise originating fromtenporary construction sites as a result ofconstruction activity are e)€nìpt flomthe noise limits
ofECC Chapter 5.30 onþ during the hours of 7:00am to 6:00pm on weekdays and l0:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise orþinating from construcfion 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 Cþ of Edmonds, Washington, its ofücials, employees, and agents from any and all claims for damages of
u¡Lqfar¡arnafrrra âriciñft áire¡+h¡ ^ri-.lir-^+k' ff.nn+ho i"¡'.--^- f^'iL;" ^o*i+ t"""o-¡a ^f+1"í¡ ^-'*;f "L-ll ñ^+ L- .I^-ñ-.t +^vr lIrù Pvrtrrr
modify, waive or reduce any requirements of any Cþ ordinance nor limit in any way the City's abilify to enforce any ordinance
provision.
. Call for locates ofunderground utilities priorto any excavation.
THIS FERMIÏ AUTHORZES ONLY THE WORK NOTED. THIS FERMTT COVERS WORK TO BE DONE ON FRMATE FROPERry ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDÉWALKS, DRIVÉ1A/AYS, IVARQUEES, ETC.) WLL REQUIRE SEPARATE FERMISSION. PERMrI
TIME LlMlf: SEE ECDC 19.00.005(A)(6)
INSPE('TIONS
I O SCI IEDIJLE INS I'E('TIONS
BUILDING ENGI NEERI NG 14251 771û220 Ð(T. r 326
1. Go to: wwn.edmondswa.gov
2. Then: Services
3. Then: Permits/Delelopment
4. Then: Online Permit lnfo
5: lf you don't hare one already, create a
login (upper right hand corner)
6: Schedule vour inspection
Building Department lnspections
are now scheduled online. lf you
harc dificulties, please callthe
Building Department font desk for
assistance during ofice hours.
(425) 771-0220
Ff RE (425)775-7720
PUBLTC WORKS (4251 771 4235
RECYCLT NG (4251 27 54801
When calling for an inspection please leale the following information: Permit Number, Job Site Address, Type of lnspection
Contact Name and Phone Num Date and whether morni or aftemoon.
. B-Plumb Gound Wotk. ÞGas Test/Pipe
BUITDING PERM¡T
APPTICAÏION
Developmenl Services
Building Division
121 sth Ave N / Edmonds, WA 98020
425.771.0220c. l8
For handouts, submittal requ¡rements, permit status and inspection
scheduling information go to: www.edmondswa.gov.
PLEASE NOTE: lntake appointments are required for New Single Family
Residences, lorge Additions, ADU's, New Commercial, and Mojor lenant
lmprovement application submittals. lf 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 cali 425-777-0220 to scheduie on intøke oppointmenti
Permir#: 2014-O7¿13
)fii(:e llse ()nr\
n Accessory Structure/
Detached Garage
tr Addition
tr Demolition p-$echglical
tr New Single Family / Duplex ffi^r*-,
! Fire Sprinkler
\__'---
f1 Remodel
JOB SITE INFORMATION/IOCATION: (Where the work is taking place)n New Commercial/ Mixed Use ! Re-Roof
Job Site Address:n Signs n Tank
Parcel:n Othern Tenant lmprovement
Lot /Unit/Suite #: _ Subdivision:
PROPERTY OWNER:
Name: I-l/er/,-r¡n/q
Remodel Permll fees ore bosed on:
The vqlue of lhe work performed. lndicqte lhe vqlue (rounded to
the neqrest dollor) of oll equipment, mqleriols, lqbor, overheod,
qnd the profit for the work indicoted on this opplicotion.
Voluotion:
Mailing Address:(...'/
City/State/Zip:
Phone #:
Email Basement sq ft:Finished tr Unfinished I
OWNER INSTAILATION: *lf yes, read and sign*
Will work be performed by the property owner? tr Yes n No
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
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
L8.27.O90.
Owner Signature:Deck/Covered Porch/PatÍo
APPTICANT / CONTACT INFORMATION:Other sq ft
Name of Applicant 4¡r
Mailing Address te,/", --
\
city/state/zip
Phone #:-3
E-mail I
GENERAT (¡f d ifferent from
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
I certify that the information I have provided on this form/applicatíon 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 ofSTATE UBI #:
Edmonds.
CITY OF EDMONDS BUSINESS LICENSE #:
Print Name:
WA STATE CONTRACTOR t & I #: (CCB) & EXPIRATION DATE:
Signature:Date k/r-t"l
TYPE Ot PERMIÍ (Provide Detoils on Poge 2)
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
PROJECT DESCRIPTION
Occupancy Group(s)Occupant Load(s):
Type(s) of Construction:Fire Sprinklers: Yes E No E
WA STATE ENERGY CODE: lf 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.
Tl / CHANGE OF USE / NEW BLDG: lnclude TRAFFTC TMPACT worksheet
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
A¡r 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
Qtv atv
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:
GENERAL COMMERCIAL DATA
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
PLUMBING FIXTURE COUNTS (New, Relocated or re-piped)
BTUs Qty BTUs Qty
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ lnsert Other:
Furnace Other:
Qtv Qtv
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medical - Surgical Vacuum Other:
Type of structure to be demolished:
Square footage of structure to be demolished
AHERA Surveydone? Y/N PSCAA Case #:
Critical Areas Determination:
Study Required E Conditional Waiver E Waiver E
Fill in Place I Fill Material:
Removal E Size of Tank (Gallons)
Critical Areas Determination :
Study Required E Conditional Waiver fl Waiver E
Grading: Cut cubic yards
Filt cubic yards
Cut / Fill in Critical Area: Yes E No E
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 & lndustries and have a
current City of Edmonds Business License.
GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re-piped)
DEMOLITION
TANK
G RADE/Fr LLlEXCAVATE
GENERAL PROVISIONS