1472_001.pdfCITY OF EDMONIDS
I2I 5TH AVENUENORTH - EDMONDS,'WA 98020
PHONE: (425)771-0220 - FAX: (425)771-0221
STATUS: ISSUED 06/1912019
Expiration Date : l2ll9 /2019
Parcel No: 0043 1200002401
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BTJILDIN(; PBIIMIT
PtÌOPEI{TY'OWNER {PPLIC AN'I-(]ONTRA('TOR
TESFAGHABER & TEKEA BERHANE
8120 200th sT sw
EDMONDS, WA 98026
(206) 26s-9699
TESFAGHABER & TEKEA BERHANE
8120 200th sT sw
EDMONDS, WA 98026
(206) 26s-9699
TESFAGHABER & TEKEA BERHANE
8120 200rh sT sw
EDMONDS, WA 98026
{206) 26s-9699
LICENSE #: EXP:
,t ()tì t)ns(. RIt'Tt()N
1" WSL
VALUATION: $0
PERMIT TYPE: Residential PERMIT GROUP: 47 - Ph¡rnbine
GRADING: N CYDS: O TYPE OF CONSTRUCTION:
RETATNINGWALL ROCKERY OCCUPANT GROUP:
OCCUPANT LOAD
FENCE: f 0X0 FTI CODF,:
OTHER: ------ OTHERDESC:ZONE:
NUMBER OF STORIES: O VESTED DATE
I ST FI,OOR: O 2ND FI,OOR: O
LOT #
BASEMENT:O2ND FI,OOR: O
NUMBER OF DWELLINGUNITS: O
BASEMENT:O I ST FLOOR: 0
3RDFLOOR:0 GARAGE:0 DECK:0 OTHER:0 3RD FLOOR: 0 GARAGE:0 DECK: 0 OTHER: 0
BEDROOMS:0 BATHROOMS:0 BEDROOMS:0 BATHROOMS:0
lixts f'l\(, \Iil.t\l, lt( ) l,{ ) s lìl)
^
lì h,\
REQUIRED: PROPOSED:REQUIRED: PROPOSED:REQUIRED: PROPOSED:
HEIGHT ALLOWED:0 PROPOSED:O REOUIRED: PROPOSED:
SETBACK NOTES:
F'RONT SETBAC-I{S ¡I)[] S ETIì A( ]I(lì.EAlr sEIlìAcK
I AGREE TO COMPLY WTH CÍTY AND STATE LAWS REGULATTNG CONSTRUCTION AND IN DOING THE WORK AUTHORZED THEREBY, NO
FERSON WLL BE EMPLOYED IN VIOLAÏON OF THE LABOR CODE OF THE STATE OF WASHINGTON RB-ATING TO WORKMEN'S COMPENSATION
INSURANCEAND RCW 1 8:27.
THIS APPLICATION IS NOT A FERM]T UNTIL SIGNED BY THE BUILDING OFFICAL OR HIS/HER DEPIJTY AND ALL FEES ARE PAID.
PERMIT APPROVAL
å/ TçÇa eø rê ,r ø/ -/€ '/ ¿ P¿"nàø. ,t/nho* 6t1gt1g--Eigñ'fiure 'ftínt'Nanr;baté r Released By Date
ATTENTION
ITIS UNLA'WFULTO USE OR OCCUPY A BUILDING ORS'IRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCI09/ IBCI IO/ IRCI IO.
FIRE APPLICANT ASSESSOR CITY
(]OND¡T¡ONS
STATUS: ISSUED 8LD20190744
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 pemit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of L¿bor &
Industries Ef ectrical Divi sion at 425-29G1400.
Final approval on a project or final occupancy apploval nn¡st be granted by the Building Official prior to use or occupancy of
the building or structure. Checkthe job card for all required Cþ inspections including final project approval and final
occupancy inspections.
Any request for altemate design, nrodification, variance or other administrative deviation (hereinafter "variance") fiom
adopted codes, ordinances or policies must be specificalþ requested in writing and be called out and identified. Processing
fees for such request shall be established by C-ouncil and shall be paid upon submittal and are non-refundable.
Approval of any plat or plan containing provisions which do not conply with city code and for which a valiance has not been
specificalþ identified, requested and considered by the appropriate cþ ofücial in accordance with the appropriate provision
ofcity 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 e)€mpt fiomthe noise limits
of ECC Chapter 5.30 only 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 originating from construction sites/activities must comply with tlre
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Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the Cþ ofklmonds, Washington, its ofücials, employees, and agents from any and all claims for damages of
whatever nature, arising directþ or indirectþ fl'omthe issuance for this permit. Issuance ofthis pemit shall not be deemed to
modif , waive or reduce any requirements of any City ordinance nor limit in any way the Cify's abilify to enforce any ordinance
provision.
Owner/Contractor to provide Water Service Line asbuilt at final inspection. See City Standards for requirements.
THIS PERMIAUTHORZES ONLY THEWORK NOTED. THIS FERMII COVERS WORK TO BE DONEON FRIVATE FROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOI\4AIN (CURBS, SIDÉWALKS, DRMÉWAYS, MARQUETS, ETC.) WLL REQIJIRE SEPARATE PERMISSION. FERMT
TIME LIMII: SEE ECDC r 9.00.005(AX6)
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INSPE('TIONS
I O SCHT]DULE INS P[I--I"IONS
BUILDING ENGTNEERI NG (4251 77 1 4.220 EXT. I 326
1. Go to: www.edmondswa.gov
2. Then: Sen¡ices
3. Then: Permits/Dewlopment
4. Then: Online Permit lnfo
5: lf you dont haw one already, create a
login (upper right hand corner)
6: Schedule your inspection
Building Depaft ment lnspections
are now scheduled online. lf you
hale diffculties, please callthe
Building Department ftont desk for
assistance during offce hours.
(425)771-0220
FIRE (425) 775-7720
PUBLIC WORKS (4251 77 1 423s
RECYCLT NG (4251 27 54801
When calling for an inspection please leaw the following information: Permit Number, Job Site Address, Type of lnspection
Contact Name and Phone Number Date and whether mornt or afternoon.
E-Water Service Line
c. l8
BUITDING PERMIT
APPTICATION
Development Services
Building Division
l21 sth Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.gov.
PLEASE NOTE: lntake appointments are required lor New Single Family
Residences, Lorge Additions, ADU's, New Commercial, and Major TenanT
lmprovement application submittals. lf plans are prepared by a profession-
al, electronic files are requested in additíon to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please coll 425-77i-A220 to schedule øn intøke øppoíntment!
Permil #
)ttl( r-- Use ( )nt\
JOB SITE INFORMAT¡ON/LOCATION: (Where the work is taking place)
Job Site Address:
Parcel:
rA
àøtaót \/\/4 1f OZ6
Lot /Unit/Suite #: _ Subdivision
PROPERTY OWNER:
Name:
Mailing Address: llTn ?øO þh s+ Çt¡t,
City/State/Zip EÅ m.t n.l < \,â/A O fÐ2-/-
Phone #:
Email:
OWNER INSTAILATION: *tf yes, read and sign*
Will work be performed by the property owner? {Ves I ruo
I own, reside in, or will reside in the completed strúcture. 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
APPUCANT / CONTACT TNFORMATTON:
Name of Applicant:
Mailing Address
City/State/Zip:
Phone #:
E-mail:
GENERAI CONTRACTOR: (lf different from applicant)
General Contractor:
Mailing Address
city/state/zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS IICENSE #:
WA STATE CONTRACTOR t & I #: (CCB) & EXPIRATION DATE:
n Accessory Structure/
Detached Garase
tr Addition
tr Demolition ! Mechanical
n New Single Family / Duplex fflumbing
n Fire Sprinkler ! Remodel
tr New Commercial/ Mixed Use ! Re-Roof
n Signs n Tank
tr Tenant lmprovement tr Other
Remodel Permll fees ore bosed on:
The volue of the work performed. lndicote fhe volue (rounded to
the neorest dollor) of oll equipmenl, moteriols. lobor, overheqd,
ond the profil for the work indicoted on lhis opplicotion.
Voluolion:
Finished n Unfinished IBasement sq ft:
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft
Deck/Covered Porch/Patio:
Other sq ft:
NA,t ) /t)a *¿ r Urw,,
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 appl¡cation to the City of
Edmonds.
Date
/ t,
Print Name:
Signature:
IYPE OF PERMIT (Provide Deloils on Poge 2)
PROPOSED NEW SqUnnE FOOTAGE FOR THtS AppLtCATtON
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 TRAFFIC IMPACT worksheet
BTUS Gas / Elec I 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 ìf a Commercial Bldg)
Other:
Qtv Qtv
Clothes Washer Tub/ Showers
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Founta¡n Pressure Reduction/ Regu lator Valve
Floor Drain/Sink Refrigerator Water Su pply
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
MedicalAir Other
Medical - Surgical Vacuum Other
Type of structure to be demolished
Square footage of structure to be demolished
AHERA Surveydone? Y/N PSCAA Case S:
Critical Areas Determination:
Study Required n Conditional Waiver E Waiver L
Fill in Place ! Fill Material:
Removal E Size of Tank (Gallons)
Critical Areas Determination :
Study Required D Conditional Waiver E Waiver E
Grading: Cut cubic yards
Fill cubic yards
Cut / F¡ll in Critical Area: Yes E No E
APPLICATIONS: ApplicatÍons are valid for a maximum of l 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
GRADE/Fr LLlEXCAVATE
GENERAL PROVISIONS