1778_001.pdfCITY OF EDMONDS
12I 5TH A\iENI.JENORTH - EDMONDS, V/A 98020
PHONE: (AÐ 77 1-0220 - FAX: (425) 77 rïnrc. I
STATUS: ISSIIED 07 D3l20l9
Expiration Date: 0l /23 12020
Parcel No: 27043 100400400
PROI'EIITI'OWNEIì,dPPLI( ANÏ'C]ONTtI.ACTOR
SARFRAZ A & SHAISTA N MALIK
23803 78TH AVE W
EDMONDS, !trA 98026-882 I
$A,RFRAZ A & SHAISTA N MALIK
23803 78TH AVE W
EDMONDS, WA 98026-8821
SARFRAZ A & SHAISTA N MALIK
23803 78TH AVE W
EDMONDS, WA 98026-8821
LICENSE#: EXP:
.IOB DLSC-RIP-I'ION
PERMIT TYPE: Residential lrenvlr GROUP: 47 - Plurnbing
GRADING: N CYDS: O ITYPE oF CoNSTRUCTIoN:
RETAINING WALL ROCKERY:loccup¿Nr cRouP
loccupeNt loeo
FENCË. f 0X0 FT)lconp.
OTHER: ----- OTHER DESC:lzoNE:
NUMBER OF STORIES: O IVESTED DATE
OF DWELLING S: 0 #
3RDFLOOR:0 GARAGE:0 DECK:0 OTHER:0 l¡Ro ruoon: o GARAGE: o DECK: o orHER: o
BEDROOMS:0 BATHROOMS:0 lsgnRooN4s: o BATHRooMS: o
GAS PIPINGFROM MSTERTOHOUSE& THENTO STOVE. CAPPINGOFFATDRYERFORFUTURECONNECTION.
VALUATION: $0
Nane Date By Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCruRE UNTIL A FINAL INSPECTON HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANIED. UBCI 09/ IBCI I O/ IRCI I O.
REQUIRED: PROPOSED:REQUIRED: PROPOSED:REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REOUIRED: PROPOSED:
SETBACK NOTES:
FRONl'SETIìA(]K S IDES EI'BA( -I(R["tR SETIì,\(]li
IAGREETO COMPLY WTH CÍTY AND STATE LAWS REGULATING CONSTRUCTON AND IN DOING THEWORK AUTHORZED THEREBY, NO
PERSON WLL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REATING TO WORKMEN'S COMPET{SATION
HIS/HER DEPUTY AND FEES ARE PAID.
INSURANCEAND RCW 18:27
PPLICATION IS NOT A FERMTT UNTIL SIGNED BY THE BUILDING
PERMIT APPROVAL
FIRE APPLICANT ASSESSOR CITY
(]()ND¡T'IONS
STATUS: ISSUED 8LD20190913
¡ Gas pipe test must be observed by City Building Inspector, affìdavits shall not be accepted.. Final approval on a ptoject 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 Cþ inspections including fìnal project approval and final
occupancy inspections.
. Any request for altemate design, modification, variance or other administrative deviation (hereinafter "variance") û'om
adopted codes, ordinances or policies must be specificalþ requested in writing and be called out and identified. Processino
. *.* for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
. Approvai of any piat or pian containing provisions which rio not compiy with city cocie anci fbr which a variance has not been
specificalþ identified, requested and considered by the appropriate city ofücial in accordance with the appropriate provision
ofcþ code or state law does not approve any iterns not to code specification.¡ Sound/Noise originating fromtemporaly construction sites as a result of construction activity are e)€mpt û'omthe noise limits
of ECC Chapter 5.30 onþ 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 cornply with the
noise limits of Chapter 5.3Q 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 klmonds, Washington, its officials, employees, and agents fiom any and all claims for damages of
--L-¿^-.-.----¿---.^ ^-,:-t,-- Jt--- -!L- -.. : t:wl4tt,vçr ilalutç, artsutB uusuuy uI lfrorrccuy x-om lne tssuance lor Inß penrut. Issuance oI tnls peffrfi snall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's abilify to enforce any ordinance
provision.
THIS PERMTAUTHORZES ONLY THEWORK NOTED. THIS FERMTT COVERS WORK TO BE DONEON PRMATE FROFERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDËWALKS, DRIVÉI^/AYS, I\IARQUEES, ETC,) WLL REQUIRE SEPARATE PËRMISSIoN. PERMIT
TIME LlMlr: SEE ECDC 19.00.005(A)(6)
INSI'E('TTONS
I O SCHEDI]I-E INS PECTIONS
BUILDING ENGI NEERT NG (42s1 77 1 -0220 EXT. I 326
1. Go to: www.edmondswa.gov
2. Then: Services
3. Then: Permits/Derælopment
4. Then: Online Permit lnfo
5: lf you don't haw one already, create a
login (upper right hand comer)
6: Schedule vour inspection
Building Department lnspections
are Row scheduled online. lf you
harc diffculties, please call the
Building Department front desk for
assistance during offce hours.
(425) 771-0220
FIRE (425) 775-7720
PUBLTG WORKS 14251 77 1-0235
RECYCL| NG (4251 27 54801
When calling for an inspection please leaw the following information: Permit Number, Job Site Address, Type of lnspection
bei Contact Name and Phone Number Date Preferred and whether or afrernoon
a
a
&Gas Test/Pipe
B-Plumbing Final
BUITDING PERMIT
APPTICATION
Development Services
Building Division
l2t sth Ave N / Edmonds, WA 98020
425.77'1.0220
For handouts, submittal requirements, 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 Major Tenant
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 call 425-777-0220 to schedule on intake oppointment!
Permil #
Ottice tJse ()nr\
I Accessory Structure/
Detached Garage
tr Addition
tr Demolition tr Mechanical
n New Single Family / Duplex tr Plumbing
l-l Fire Snrinkler l-l Remodel
JOB SITE INFORMATION/LOCATION: (Where the is taking place)tr New Commercial/ Mixed Use ! Re-Roof
Job Site Address:D Signs tr Tank
Pa rcel:tr Tenant lmprovement Other
Lot /Unit/Suite #: _ Subdivision
PROPERTY OWNER:I
Remodel Permil fees qre bosed on:
The volue of fhe work performed. lndicole the volue (rounded to
fhe neorest dollor) of oll equipmenl, moieriols, lobor, overheod,
ond lhe profit for the work indicoled on lhis opplicolion.
Name:L IL
Mailing Address:
Voluolion:
City/State/Zip:
Phone #:
Email t
rt'i|Basement sq ft:Finished ! Unfinished n
OWNER INSTAILATION: *lf yes, read and sign*
1st Floor, sq ft:
Will work be performed by the property owner? tr Yes tr 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
2nd Floor, sq ft:
intended for sale, lease, rent,or accord¡ng to RCW Garage/Carport:, sq ft:
18.27.090.l--Owner Deck/Covered Porch/Patio:
APPUCANT / CONTACT TNFORMATTON:Other sq ft:
Name of Applicant:
Mailing Address
City/State/Zip
Phone #:{ì
E-mail
GENERAL CONTRACTOR: (lf different from applicant)
General Contra
Mailing Address:
Phone #:
E-mail
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 ownerto submit a permit appl¡cation to the City ofSTATE UBI #r
Edmonds.llCITY OF EDMONDS BUSINESS [ICENSE #:
WA STATE CONTRACTOR L & l#: (CCB) A EXPIRATION DATE:
Name FR/-7
Date
r4/-.Lìt
TYPE OF PERMIT (Provide Deloils on Poge 2)
PROPOSEÞ NEW SQUARE FOOTAGE FOR THIS APPLICATION
PROJECT DESCRIPTION
ä
î
Occupancy Group(s)Occupant Load(s)
Type(s) of Construction Fire Sprinklers: Yes ! No n
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 / Other Qty
A/C Unlt /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions ¡f a Commercial Bldg)
Other
Qtv Qtv
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 fr other: 4â3 PtPifl{K
()/To¡lets oil''er,$r1r.r-, fl"le
GENERAL COMMERCIAL DATA
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
PLUMBING FIXTURE COUNTS (New, Relocated or re-piped)
S
BTUS Qty BTUS Qty
A/C Un¡t Outdoor BBQ/ Fire pit
Boiler Stove/Ra nge/Oven I
Dryer waterHeat{+Ð:'fà-
Fireplace/ lnsert Other:N.,
Furnace Other:
Qtv Qtv
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medical - Surgical Vacuum
Type of structure to be demolished
Other:
Square footage of structure to be demolished
AHERA Surveydone? Y/N PSCAA Case #:
Critical Areas Determ¡nation:
Study Required ! Conditional Waiver n Waiver !
Fill in Place ! Fill Material:
Removal n Size of Tank (Gallons)
Critical Areas Determination:
Study Required n Conditional Waiver ! Waiver !
Grading: Cut cubic yards
Fill cubìc yards
Cut / Fill in Critical Area: Yes E No I
APPLICATIONS: Applications are valid for a maximum of l year
ESLHA Applications, 2 years.
ùurrent Citv of Edmorids Business License. r+ñ Lro, ts + -t-Ò J ã.r.:olla¡ytr
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & lndustries and have a
GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re-piped)
DEMOLIÏION
TANK
GRADE/FILL/EXCAVATE
GENERAL PROVISIONS