20170217135203.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH — EDMONDS, WA 98020
PHONE: (425) 771-0220'— FAX: (425) 771-0221
STATUS: ISSUED 02/17/2017uuuuumuumiuiuinni000�Auuuuuuu��ui��i�louuuuuu�mo�ouuuuuu�:,�l�rn��m�ma��m��r�a����r��a
Expiration Date: 08/17/2017
Parcel No: 00615800000200
CRMA INVESTMENTS LLC
LACEY, WA C/O ,CESARRUIZ
834'NE 195TH ST
SHORELINE, WA 98155
(206) 3 13-5688
RESIDENTIAL RE -ROOF. NO SHEATHING ,
VALUATION: $0.00
CONTRACTOR
RUCTION INC C J NORTHWEST CONSTRUCTION INC
C/O CESAR RUIZ
834 NE 195TH ST
SHORELINE, WA 98155
(206)313-5688:
LICENSE #: 1CJNORJN,977MZ EXPO'
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 NOT A P[;^ lT UNTIL SIGNED BY TJJE B1 LDJNG OFFICIAL OR 111t[W14 DEPUTY AND ALL FEES ARE PAID,
t-,� h r) rcp =ao,
01re Print Name Date Released 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. UBCI09/ IBC1101 I RC110.
ONLINE = APPLICANT = ASSESSOR OTHER
• Final approval on a projector 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.
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• 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 from temporary construction sites as a result of construction activity are exempt fromthe noise limits
of 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 ofhis 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.
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 SEPARATE PERMISSION.
PERMIT TIME LIMIT:` SEE' EC D C '19.00.005(A)(6)
PUBLIC WORKS (425)771-0235 PRE-TREATMENT 25i 672-5755 RECYCLING 425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
reqpesteContact Name and Phone Number, `Date Prefereed,'andwhether nu Eefer morning,or afternoon.
B-Roof Tear Off
B-Building.Final
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City of Edmonds
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
D -3?) 5 ) 0 Aj. �A/
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ NoA I
APPLICANT: Phone: Fax:
CS NO C-1,111 Z04--in wrl
Address (Street, City, State, Zip): 1�# (� E-Mail Address:
PROPERTY OWNER: Phone: Fax:
d LL .-
Address (Street, City, State, Zip): E-Mai Auld ess:
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E-Mail Address:
CONTRACTOR:* A ! � C6 S I�� �G� f � Phone Fax:
IV /
Address (Street, City, State, Zip), 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 425.775.2525 City Business License P/ xp. Date:
r (Z 0Z41 � )Z ,jIh
PLUMBING
DETAIL THE SCOPE OF WORK:
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rv1 1 ta1.
MECHANICAL
TANK V I DEMOLITION
rA
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 prtalt ,t r or duly authorized agent of the property owner to submit a permit application to the City of
Edmonds.
❑ A ent/Other X(specify):Print Name: .... _ ..�.� _. wner gZ O ...._�.._.. _.
Signature: Date. ...... _. _ ....�:..�.
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FORM C L:\Building New Folder 2010\130NE & x-ferred to L-Building-New drive\Form C 2014.docx Updated: 1/17/2014