1503_001.pdfCITY OF EDMONIDS
I2I 5TH AVENI.IE NORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX:(425) 77t-0221àc. I
STATUS: ISSIIED 0612012019
Expiration Date : 12120 /2019
P arcel No: 0043 42077 027 00
PR()PF,lt'l-Y OWNlìlt dPPLI(ìAN'I'c()N'l-RA("1'olì
THOMASM & GEORGIA VSNYDER
837 DAYTON ST
EDMONDS, WA 98020
(42s) 77s-2620
PRICOR
CiO ALEX BIRCH
2825 S l54TH ST
SEATAC, WA 98188
(206) 258-s270
PRICOR
C/O ALEX BIRCH
2825 S 154TH ST
SEATAC, WA 98188
(206) 2s8-s270
LICENSE #: PRICOTLS6SKZ EXP0510912020
,IOB DLSCIIIP]ION
40'oF 1" WSL
VALUATION: $0
PERMIT TYPE: Residential PERMIT GROUP:47 - Plumbing
GRADING: N CYDS: O TYPE OF CONSTRUCTION:
RETAININGWALL ROCKERY OCCUPANT GROUP
OCCUPANT LOAD
FENCE: ( 0X0 FT.)CODE:
OTHER: ------- OTHER DESC:ZONE:
NUMBER OF STORIES: O VESTED DATE
2ND FLOOR: 0
NUMBER OF DWELLINGUNITS: O
BASEMENT:O 1ST FLOOR: 0 1ST FLOOR: 0 2ND FLOOR: 0
LOT #
BASEMENT:O
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
li\ts.tIN(; .\t{t.t'\l'l{() l'()s l,ll) ¡\l{l'-A
lneeulRno: PRoPoSED:REQUIRED: PROPOSED:REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:0 lnrouln¡t: PRoPoSED:
SETBACKNOTES:
S IDF, S EfBA(]K REAII. SETBACI(F-RONI'S IìI'BACI(
I AGREE TO COMPLY WTH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZ ED THEREBY, NO
FERSON WLL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPB{SATION
INSURANCEAND RCW I 8:27.
IS NOTA FERMI-T UNTIL SIGNED BY THE BUILDING AND FEES ARE PAID.
PERMIT APPROVAL
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 HASBEEN GRANTED. UBCI09/IBCI IO/ IRCI IO.
FIRE APPLICANT ASS6SOR CITY
(ioNDtl'toNS
STATUS: ISSUED BLD2019 07 52
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 604.3). A state electrical permit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of l¿bor &
Industries Electrical Divi sion at 425-290-1400.
Final approval on a project or final occupancy approval must be granted by the Building Official pdor 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 altemate design, modification, variance or other administrative deviation (hereinafter "variance") from
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 Council and shall be paid upon submittal and are non-refundable.
a
Approval of any plat or plan containing provisions which do not conply with city 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 iterns not to code specification.
Sound/Noise originating fromtemporary construction sites as a result ofconstruction activity are e)€mpt fiomthe noise limits
of ECC Chapter 5.30 onþ during the hours of 7:00amto 6:00pm on weekdays and l0:00am and 6:00pm on Saturdays, e><cluding
Sundays and Federal Holidays. At all othertimes the noise originating fiom construction sites/activities must compty with the
-^:-^ ¡:---:.- ^C^--,-.-,- E .^ ----t---trurùç lllilllù ur \-Irap[çr J,JU, unlEsS a vananue nas oecn granteo pursuanl Io EÅ-L f,,JU.tzu.
Applicant, on behalf ofhis or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the Gty of Rlmonds, Washington, its offìcials, employees, and agents fiom any and all claims for damages of
whatever nature, arising directþ or indirectþ fiom the issuance for this permit. Issuance ofthis permit shall not be deemed to
modiS,, waive or reduce any requirements of any Cþ ordinance nor limit in any way the City's abilþ to enforce any ordinance
provision.
Owner/Contractor to provide Water Service Line asbuilt at fural inspection. See City Standards for requirements.
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INSPII-IIONS
THIS FERMT AUTHORIZES ONLY THE WORK NOTED. THIS FERMTT COVERS WORK TO BE DONE ON FR'VATE PROPERry ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOÍVAIN (CURBS, SIDÉWALKS, DRMËWAYS, MARQUEES, ETC.) WLL REQUIRE SEPARATE PERMISSION. FERMT
TIME LIMIr: SEE ECDC 19.00.005(A)(6)
TO S CHU)ULE INS PFI'TIONS
BU¡LDING ENGTNEER|NG (425) 771{220 EXT. 1326
1. Go to: www.edmondswa.gov
2. Then: Services
3. Then: Permits/Dewlopment
4. Then: Online Permit lnfo
5: lf you don't haw one already, create a
login (upper right hand corner)
6: Schedule your inspection
Building Department lnspections
are now scheduled online. lf you
have diffculties, please call the
Building Department front desk for
assistance during ofice hours.
(425) 771-0220
F|RE (425) 775-7720
PUBLIC WORKS (4251 77 1 4235
RECYCLT NG (4251 27 s4801
When calling for an inspection please learæ the following information: Permit Number, Job Site Address, Type of lnspection
bei Contact Name and Phone Number Date Preferred and whether m or aftemoon.
a E-Water Service Line
BUITDING PERMIT
APPTICATION
Development Services
Building Division
l21 slh Ave N / Edmonds, WA 98020
42s.771.0220
For handouts, submittal requlrements, permit status and inspection
sch e d u I i n g i nf o rm ati o n go to : lywlg.edlgçþlyg.gey.
PLEASE NOTE' lntake appo¡ntments are required for New Single Family
Residences, lorge Additions, ADU's, New Commercial, and Moior Tenanr.
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.
Pleose coll 425-777-0220 to schedule an íntoke appoíntment!
'157)Permil #:
)tt (ìe l.l\-- ( )rìl\
JOB SITE INFORMATION/IOCATION: (Where the work is taking place)
Job Site Address:917 /u',lon 5l
Parcel
Lot /Unit/Suite #:
-
Subdivision
PROPERTY OWNER:
Name:
Mailing Address:
C¡ty/State/zip:
Phone #:+2\ ,77 S - )t) o
Email
OWNER INSTAILATION: *lf yes, read and sign*
Will work be performed by the property owner? ! Yes S 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
L8.27.O90.
Owner Signature:
APPLICANT/ CONTACT I NFORMATION:
Name of Applicant:A l, r ß,'nc /(¡ ".)t
Mailing Address Ltzs J tS41 I1
City/State/Zip l-c t-A '1.8/ t
Phone #:LoL- 2l k szzt'
E-mail:
GENERAT CONTRACTOR: (lf different from applicant)
General Contractor: /.)Lo. fc./,z,'/.si" S
Mailing Address L*21 5 ßqf 1 /
City/State/Zip:1r-L,.LA "t ç/str
Phone #:zoe- 2E ll -ç7o
E-mail:
STATE UBI #:l"o?)16ß3í
CITYOF EDMONDSBUSINESSTICENSE ¡, N[I- TZ2&S 9
WA STATE [ & I #: (CCB) & EXPIRATION DATE:
5/q /2ç/Llc"'lt
! Additionn Accessory Structure/
Detached Garage
tr Mechanicaltr Demolition
fl elumbingtr New Single Family / Duplex
n Remodeln Fire Sprinkler
! New Commercial/ Mixed Use n Re-Roof
! Tank! Signs
! Other! Tenant lmprovement
Remodel Permil fees ore bqsed on:
The volue of lhe work performed. lndicqte the volue (rounded to
lhe neorest dollor) of oll equipment, mqteriols, lobor, overheqd,
ond the profil for the workindicoted on this opplicotion.
Voluolion:
Finished ! Unfinished nBasement sq ft:
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
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
Other sq ft:
kp/.-.
I 1L
Date M
{ot "{ l" tu*/"./,r, {..^
l'¡o-Sl/lofer l.
Print Name:
Signature:
Edmonds.
TYPE OF PERMIT (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: tnclude TRAFFTC tMpACT worksheet
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heatíng
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
Qtv Qtv
Clothes Washer Tub/ Showers
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Founta¡n 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 ary
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 ! Conditional Waiver I Waiver E
Fill in Place n Fill Material:
Removal E Size of Tank (Gallons)
Critícal Areas Determination:
Study Required E Conditional Waiver E Waiver fI
Grading: Cut cubic yards
F¡I¡cubic yards
Cut / F¡ll in Critical Area: Yes E No E
APPLICATIONS: Applications are valid for a maximum of 1 year
ESLHA Applications, 2 years.
GAS/FUEL CONNECTTON COUNTS (New, Relocated or re-piped)
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re-piped)
DEMOLITION
TANK
G RADE/FILL/EXCAVATE
GENERAL PROVISIONS
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 L¡cense,