20170302114013.pdf01: E, b At
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 03/02/2017
Expiration Date: 09/04/2017
Parcel No: 00639900200100
ToTom"11
Pro.juc(Address: .55-5 ALDER -ST911L EDMON1
CAROLYN JUSTUS
CAROLYN JUSTUS
OWNER EXEMPTION
555 ALDER ST UNIT B1
555 ALDER ST UNIT B I
C/O CAROLYN JUSTUS
EDMONDS, WA 98020-3485
EDMONDS, WA 98020-3485
5 5 5 ALDER ST UNIT B I
EDMONDS, WA 99020-3485
(281) 734-8352
(281) 734-8352
(281) 734-8352
LICENSE #: EXP:
INSTALL WASHINGMACHINE HOOK UPS.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alteration/Remodel
GRADING. N CYDS: 0
TYPE OF CO STRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE: 2015
OTHER: ------- OTHER DESC:
I ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 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
FR0N'I'SFI"BA('K S1I)VSFFRA('K R LA 11 S FYR A('K
REQUIRED: PROPOSED REQUIRED: PROPOSED: =7R—EQUIRED: 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 RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THIS APPLZATIONYS NOT A PI:RMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR I lIS/I 1):R DEPUTY AND ALL FEES ARE PAID-
/- "/- �- I I ('�' T, j b,> �/�! 01;4- K-Ju h P1 ,, Q-�Wr�
Name Date
ed 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 7;7-1 OTHER ksp
STATUS: ISSUED BLD20170307
-CONDITIONS
• 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. Cbeck 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
specifica]Ily 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 s ites as a resu It of construction activity are exempt from the nois e limits
of ECC Chapter 5.30 only 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 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 pen -nit. Issuance ofthis 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)
EXT. 1333
FIRE
I PUBLIC WORKS (425) 771-0235 1 PRE-TREATWIENT (425) 672-5755 T -RFJCYCLING(425)27�54801�
When calling for an inspection please leave the folloming information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Preferced, and mbether vou m-cfer morni na or afternoon.
• B-Preconstruction meeting
• B-Plumb Rough In
• B-SheetrockNail
• B-Plumbing Final
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORM D
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:
0 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).
0 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(l 1).
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
perforrn any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
0 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).
0 Licensed Architect, engineer, electrician or plumber. All work performed under this
pern-fit will be performed by an arc ' hitect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
0 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 BE OR SHE UNDERSTANDS THAT T * HE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
MIC,�-rLV,-, 20
DATED this day of
PROPERTY O,�7NER/AUTHORIZED
PERSON
Signature e�
cc' t' ) , 'J '] /'� �2
Print Name /
WITNESS.
Signature
\1� V\
Print Name
LATEMP\'BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANIDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
1215 1h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
y- 41 & 5� � I IRe��>d
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes [-] No FO
APPLICANT:
Phone:
Fax:
1
-2 9) ?'3 � 1? 3 .5'1
Address (Street. Ci S Z.-):
-t; -5- Z= j 9 -2 0
E-Mail Address:
5- 1
C " -. ( "t-
PROPERTY OWNE
Phone:
Fax:
(0, r?)�
Address (Street, City, Slime, Zi
/�j S'O 0
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* -5t (�
Phone:
Fax:
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
City Business License #/Exp. Date:
in the City. Contact the City Clerk's Office at 425.775.2525
PLUMBING-j A MECHANICAL I I TANKI
I DEMOLITION I I
DETAIL THE SCOPE OF WORK:
0�
I declare under penalty ofperjury laws that the information I have provided on this jormlapplication 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: Oviner VAgetillOther El (specify):
Date:
Signature:
FORM C LABuilding New Folder 20 1 O\DONE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014
PLUMBING
Fixture Type (new and relocated)
Total #
FIXTURE UOUNT
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
lothes Washer
Hose Bib
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes 0 No
Hydronic Heat in: Floor Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
Furnace
Gas #_*lec
#—Other:—
# BTUs: <100k— >100k—
Location(s)
Air Handler / VAV
Gas #
Flee # CFM: <10k— >10k—
#
Location(s)
(circle selected)
AC / Compressor
Boiler / Heat Pump
Gas #—Elec
#—Other:—
# BTUs:.<100k,
100k-500k, 5OOk-IMil
Roof Top Unit
HP:
<3,
"tion
3-15, 15-30 Location
(circle selected)
Hydronic Heating
Gas #—Elec
#—In-Floor
—Wall Radiant— Boiler BT�.
Location
Exhaust Fans (single
Bath #—Kitchen
#—Laundry # —Other:
#
duct)
Fireplace
Gas #—Elec
#—Other:—
# Location(s)
I Dryer Duct
I
L ------- j
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs: Location(s):
Furnace
Location(s):
Water Heater
BTUs: Location(s):
Boiler
BTUs: _�I>�fion(s):
Other:
BTUs: Locati
Fireplace/Insert
BTUs: Location(s):
Stove/Range/Oven
Dryer
BIDS
IOutdoor
I TOTAL OUTLETS
FORM C L:\Buildirig New Foider 2010\DONE & x-ferred to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014