20160628152227.pdfOV' E1) 1f
F E-D"'Mu"N'"
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Expiration D ate :
Parcel No: 00434600006403
BRAD & JACKIE CASTONGUAY BRAD & JACKIE CASTONGUAY OWNER EXEMPTION
18914 94TH AVE W 18914 94TH AVE W C/O BRAD & JACKIE CASTONGUAY
EDMONDS, WA 98020 EDMONDS, WA 98020 18914 94TH AVE W
EDMONDS, WA 98020
(206) 795-373 8 (206) 795-373 8 (206) 795-3 73 8
LICENSE #: EXP:
JOB DESCRIPTION
RUN GAS LINE METER TO BOILER SYSTEM PLUS ONE T FOR FUTURE USE.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION.
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: ( 0 X 0 FT.)
CODE: 2012
OTHER: ------- OTHER DESC:
JZONEt
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNIT S: 0
LOT #:
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 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
I 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 APPLICAdoTION IS NOT A -PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR I IIS/110 DEPUTY AND ALL FEES ARE PAID.
WAS mmmumm'o
�r , , # Date
ATTENTION
ITIS UNLAWFUL TO USE OROCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBC110/ IRC110.
ONLINE APPLICANT ASSESSOR EZ
OTHER ���
STATUS: ISSUED BLD20160862CONDITIONS
• Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
• 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 orpolicies 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 fromtemporary construction sites as a result of construction activity are exempt fromthe noise lints
of ECC Chapter 5.30 only during the hours of 7:00amto 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
hamlless the City of Edmonds, Washington, its officials, employees, and agents fromany and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance for this permit. Issuance of this permt shall not be deemed to
modify, waive or reduce any requirements 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
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 N'' ENGINTIZING (425) 771-0220 EXT. 1326 FIRE(425) 775-7720
PUBLIC WORKS 425 771-0235 PR&TREATMENT(425) 672-5755 RDCYCLING 425 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date :Prefereed, and whether youo prefer mornine or afternoon.
• B-Gas Test/Pipe
• B-Plumbing Final
c DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
" APPLICATION
121 5`Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 A Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
S , ' , City Stale, Zip). , Parcel #:
PROJECT ALILI:RI�;�S S' eel, ° Otte # L:
Subdivision/1-01 #: Project Valuation: $
Address (Sttt et City `� aX/r.
ip);
M., Y
PROPE;RTYJ)A 104:,,01a I
(SIT-Yel,pity „,Stcaq Zi
11*'ND N{,. A(,EN(,Y
dks (Street, City, State, Zip):
CONTRACTOR:�"c
*
Phone-
Fax:
l.••M<mil dth^ess.
9 'W
i'htte
Fax:
1i-Mtail Address:
Phone:
J Fax:
E-Mail Address;
Phone;
Fax:
Address (` a (pity, State, Z'°l: E-Mail Address:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.252-5 City Business License #/Exp. Date;.
DETAIL THE St OPF01° WORK:
PROPOSED NEW S T ARE FOOTAGE FOR THIS PROJECT:
Basement: � .�_ • ft. Select Basement 1" c,; Finished lInfinished
ls` Floor: ft.
T°,' Floor: ...,.e.,.... .. a. ,_ __Y....sc . ft. Deck/Cvrd Porch/Patio:.._ ... _ vtit . ft.
Bedrooms # Full
. W.W.
�' e, -3/4 3ztkl't #,,�,u; Half -Bath # Other:. .. __.
...... _ _ u �-�.�w.sr . ft.
Fire Sprinklers., Yes 7 No Retairtia Wall: Yes No
(.:el'tading.; Cut w cu. YdS. Fill cu. (k Cut/Fill in Critical Area: Yes _y No
El
I declare under penalty of perjury laws 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„
Print Name: t" _ Owner 0 gent/Other ❑ (specify) _� __ ....._...,
Signature: Date: ._���
FORMA L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.doex Updated: 1/17/2014
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORMI)
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to the City of Edmonds that:
❑ Value of work under $500.00. The aggregate contract price of labor and materials and all
other items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property, This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that he/she is
a contractor, or that he/she is qualified to engage in the, business of contractor. RCW
18.27.090.(9).
❑ Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 18.27.090(11).
Work performed personally on own property. Anyone personally working, on property
he/she owns, or at which he/she resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
❑ Use of own employees. Property, owner using him/herself or his/her own employees to
perform maintenance, repair, and. alteration work in or upon his/her own property. RCW
18.27.090(13).
❑ Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
❑ Other. Specify which provision of RCW 18.27.090 applies:
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this � a day of „ 20-1 "
PROPERTY OWNER/AUTHORIZED
PERSON,
Signature
Print Name
WITNESS.
Signature
Print Name
LATEMPWILDING\IIANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07