20161010140438.pdfF 1)'11
CITY OF EDMONDS
121 5TH AVENUE NORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 10/10/2016 Pennif'4: BLD2'0 1613,53
Expiration Date: 04/10/2017 Project Addresi: 19214 94'm PLNN".. EDMONDS
Parcel No: 00434600006003
ROBERT W KETT E NGB ROOFING NGB ROOFING
19214 94TH AVE W C/O NIKOLAY BAGOSHVILI C/O NIKOLAY BAGOSHVILI
EDMONDS, WA 98020 19215 80TH PL W 19215 80TH PL W
EDMONDS, WA 98026 EDMONDS, WA 98026
(425) 640-7347 (206) 883-6232 (206) 883-6232
LICENSE #: NGBROR*889M7 EXP:07/30/2018
TEAR OFF EXISTING TORCH ROOF, INSTALL NEW 60 MIL PVC
VALUATION: $0.00
PERMIT TYPE: Residential
I PERMIT GROUP: 54 - Re-Roof/RoofAlter/Repair
GRADING: N CYDS: 0
ITYPE OF CONSTRUCTION
RETAINING WALL ROCKERY:
JOCCUPANT GROUP:
OCCUPANT LOAD.
FENCE: 0 X 0 FT.)
CODE:
I ------- OTHERDESC:
IZONE:
-OTHER:
NUMBER OF STORIES: 0
IVESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
1BASI:MFNT 0 1 ST FLOOR: 0 2ND FLOOR 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
1BEDROOMS: 0 BATHROOMS: 0
F14ONT SI—FRAUK �S 11.) F, S FTB A Ch, REAR SFI'B/k('k
REQUIRED: PROPOSED: IREQUIRED: PROPOSED IREQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
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 RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THIS APPLICATION ISNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISMERDEPUTY AND ALL FEES ARE PAID.
5A5 ' A_4z�z� Q&i44- 1011012-01(o
Signature Print N4
By
Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR F�71 OTBER
I vl�
STATUS: ISSUED
BLD20161353
• 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 thejob 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 or policies 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.
SoundNoise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00arnto 6:00prn on weekdays and 10:00arn and 6:00prn 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
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit 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)
(',ALI, FOR INS PECTIONS
I BUILDING (425) 771-0220 EXT. 1333 MGINEERING (425) 771-0220 EXT. 1326 FIRE(425) 7 5-772
I PUBLIC WORKS (425) 771-0235 1 PRE-TREATNIENT (425) 672-5755 LING (425) 275-48FI—I
When calling for an inspection please leave the folloming information: Permit Number, Job Site Address, Type of Inspection being
reques ted, Contact Name and Phone Number, Date Prefereed, and Nvhether you prefe r morni tit., or afternoon.
• B-Roof Tear Off
• B-Building Final
A 0 E D /j,
C_; DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5h Avenue N, Edmonds, WA 98020
Phone 425.771.0220!k Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zi
�m 5m�
Parcel #:
Subdivision/Lot #:
Project Valuation: $
APPLICANT: IV45;0
Phone. -
,,.I
Fax:
AdAeVs Street State Zip)-
,7 ;- O�w, W
E-Mail AddreM.- -V,
.411�,A e-M�,!O?X-Ar4r ",
PROPERTY OWNER:,C, 4&- �4 04#Z?�
Phone:
40��7_n�'W_ �?J
Fax:
Address (Street City, State, Zip):
1'72,1,? �'O'A Nk, W !�Vo_a o/5
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:
Phone:
TFax.
Address (Street, Ci
kt. State
E-Mail Address:
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
WA State License #A-Fyp. Date:V
J6"061
A161940A �Om-7 7/? 41
C' Business License #/Exp Date -
DETAIL THE SCOPE OF WORK: 7r,--Ar O-e
kz,""
e,�7!'� 7� C n1 oto
Pz—/Z,-
PROPOSED NEW SQUARE F
OTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished L] Unfinished L]
I" Floor: sq. ft.
Garage/Carport: —sq. ft.
2 "d Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes
Ll
NoEl
I Retaining Wall: Yes
No
El
Grading: Cut cu. yds. Fill -cu.yds.
I Cut/Fill in Critical Area: Yes L-] NoEl
I declare underpenalty ofpeijury laws that the information I have provided on this formlapplication is true, correct and
complete, and that I am the propedy owner or duly authorized agent of the property owner to submit a permit application to
the City of Edmonds.
Print Name: OwnerEl Age t/011 (specify):
Signature: Date: 1rhell,�,
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.doex Updated: 1/17/2014
0 A-f
A
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
121 5'� Avenue N, Edmonds, WA 98020
City of Edmonds
iMECHANICAL
Phone 425.771.0220 It Fax 425.771.0221
Equipment Type
Appliance/Equipment Information (new and relocated) Total #
11 #1
Furnace
Gas #—Elec
#—Other:—
# BTUs: <100k— >100k— Location(s)
Air Handier / VAV
(circle selected)
Gas #
Elec # Other:
# CFM: <10k >10k Location(s)
AC / Compressor
Boiler / Heat Pump
Gas #—Elec
#—Other:—
#_ BTUs:—<100k, 100k-500k, --__500k-lMil
Roof Top Unit
HP:
<3,3-15,15-30
Location(s)
(circle selected)
Hydronic Heating
Gas #—Elec
#—In-Floor
—Wall Radiant— Boiler BTUs: Location
Exhaust Fans (single
duct)
Bath #
Kitchen # Laundry # —0ther: —#—
Fireplace
Gas #—Elec
#—Other:—
# Location(s)
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:
Location(s):
Furnace
BTUs:
Location(s):
Water Heater
BTUs:
Location(s):
Boiler
BTUs:
Location(s):
Other:
BTUs:
Location(s):
Fireplace/insert
BTUs:
Location(s):
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
Pl,[JMII[N(;
Fixture Type (new and relocated)
FIXTURE COUNT
Total # Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
Tub/Shower
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? YesE] NoE]
Hydronic Heat in: FloorE] WaIIE]
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A L:\Building New Folder 2010\130NE & x-ferTed to L-Building-New drive\Form A2014.docx Updated: 1/17/2014