20170123161933.pdfVALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP:54 - Re-Roof/Roof Alter/Repair
GRADING: N CYDS<0
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY
OCCUPANT GROUP.
OCCUPANT LOAD:
FENCE: 0 X 0 FTJ
CODE: 2015.
OTHER------- OTHER DESC:
ZONE
NUMBER OF STORIES 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
ILOT #:
1
BASEMENT:: 0 1ST FLOOR; 0 2ND FLOOR: 0
BASEMENT: 0 I ST 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
. .. . . .. . . . . . . . . ..... . . . . ....... . . ............................................ ........ . .
REQUIRED:PROPOSED: REQUIRED. PROPOSED: REQUIRED PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:'
SETBACK NOTES:
PERN111TAPPROVAL
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,
PDb1CATJON'IS'A(Y17 A PERMITTHIS UNTIL SIGNED BY THE BUILDING OFFICIAL OR 1.11W TER DEPUTY AND ALL FEES ARE PAID. -
�*n%WeV Print Name Date sed By Date
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ 113C110/ IRC110.
ONLINE APPLICANT 'ASSESSOR 5L OTHER
: ISSUED BLD20170100
• 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 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.
• Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
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 othertimes 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 inderrmify 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 fromthe 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.
INSPECTIONS
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 SEPARATEPERMISSION.
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
PUBLIC WORKS 425) 771-0235 PRE-TREATMENT 25 672-5755 RECYCLING (L25) 275-4801 `
When calling for an inspection please leave the following' information: Permit Number, Job Site Address, Type of Inspection being
• B-Roof Tear Off'
• B-Building Final
)-OiTo1o0
City of Edmonds
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5 h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 A Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT�DRESS (Street ite #, City State, Zip):
Parcel #:
Subdivision/Lot #:
Project Valuation: $
AP 1C N` :-, %
hone: Fax:
n
at ul
Address (SM,y, St te, Z° :
E-Mail Address:
r
PROPERTY OWNER:
Phone;
Fax;
C^Vv Q
Address (, °et, ty, St, t Zi ):
E-Mail Address:
LE ING AGENCY:
Phone„ Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CQNT ACTOR:
Ph a Fax:
Add e (Street City, St te, Zip):
ail Address:
VSA
lA S t License #/EXp. D
*Contractor must have a valid City of Edmonds business license prior to
lel��
doing work in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
�
� ;DETAIL
THE SCOPE OF WORK:
PROPOSED NEWSQUARE FOOTAGE
FOR THIS PROJECT:
Basement: s , ft.
Select Basement T e: Finished Unfinished
l sr Floor: s . ft.
Gara e/C ort: -.sq. ft.
2°d Floor: s . ft.
.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other:
s . ft.
Fire S rinklers: Yes 17 No
Retaining Wall: Yes 71 No 17
Grading: Cut cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes LJ No
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 tl property owner to submit a permit application to
the Cityof dmon , 1
1,1A
Print Name: Owner
Agent/Other ❑ (specify): ,
Signature: Date:
Atl
FORM A LABuilding New Folder 201000NE & x-ferred to L-Building-New drive\Form A2014.docx
Updated: 1/17/2014
DEVELOPMENT SERVICES
d
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
ci
121 5 h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 Ik Fax 425.771.0221
Equipment Type
MECHANICAL
Appliance/Equipment Information (new and relocated) Total #
Furnace
Gas #_Elec
#_Other:
# BTUs: <100k >100k_ Location(s)
Air Handler / VAV
(circle selected)
Gas #
Elec #—Other:_
# CFM: <10k_ >10k_ Location(s)_---
AC / Compressor /
Boiler / Heat Pump /
Gas #
Elec #,Other:
# BTUs: <100k, 100k-500k, 500k-1Mil
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
Bath #_Kitchen
# Laundry # #
duct)
_Other:
Fireplace
Gas #_Elec
#_Other:
# Location(s).
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:
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
Fixture Type (new and relocated)
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? Yes
No
Hydronic Heat in: Floor Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm A2014.docx Updated: 1/17/2014