20170313142113.pdf4
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Project
Parcel No: 00512400000600
LOREN FORSBERG LOREN FORSBERG LOREN FORSBERG
PO BOX 193 PO BOX 193 PO BOX 193
EDMONDS, WA 98020-4022 EDMONDS, WA 98020-4022 EDMONDS, WA 98020-4022
(206) 265-3361 (206) 265-3361
LICENSE #: EXP:
DEN40 6'X 20'EXISTING PATIO COVER ON EAST SIDE OF PROPERTY
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 23 - Demolition
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE- 2015
JOTHER: ------- OTHER DESC:
IZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT
LVMIVN��
BASEMENT: 0 1 U FLOOR: 0 2ND FLOOR: 0
"INDIRIVIAILM
BASFMENT- 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
IBEDROOMS: 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
FRONTS 17TBA(']% SIDESETBACK REA R S F]rBA(h
REQUIRED: PROPOSED: IREQUIRED: PROPOSED: �=QUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE T 0 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.
Tit K�N -LS Nur A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISIHER DEPUTY AND ALL FEES ARE PAID.
ft:i�x gL/�z± 0311311017
Siabature '\ Print Narne Date Released & 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 UBCI09/IBCII0/IRCII0.
F—]ONIJNE APPLICANT ASSESSOR EVOTHER
STATUS: ISSUED BLD20170348
('0NDITIONS
• 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 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 firnits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00arn 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 litnits 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
hanniess 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 pernit. 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 T1ME LIMIT. SEE ECDC 19.00.005(A)(6)
1333 1 ENGENEERING (425) 771-0220 EXT. 1326
PUBLIC WORKS (425) 771-0235 PRE-TREATMENT (425) 672-5755 RECYCUNG (425) 275-4801
When calling for an inspection please leave the fulloming information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
a B-Final Demolition
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 A Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suitc #, City Skate, Zip):
1 2(�
_1_11?KA14�i_lo %_SW Wk C196
Parcel #:
Subk1fivisloR/Lot �gn
0�
Prq ect Va tiation: $
APPLICANT: ,
U,.rQ,vN
Phone:
2", 2Q6---_52),d_
Fax:
Address (Street, City State Zi (2( �02
E-Mail Address:
LY4, Q Aty'. C Lyn
PROPE'RTY OWNER-
Phone:
Lek.) 2�155_3_410(
I ax:
1
Address (Strect, City, State, Z�"i)),),,',
C- Q)CA C1 A AC
F-Mail Address:
((I C (yn
I EN�"; AGENCY:
Phone:
Fax:
(Street, City, State, Zip):
E-Mail Address: —Fa
CONTRACTOR:*
Phone:
Address (Street, City, State, Zip):
E-Mail Address:
*Contractor inust have a valid Cit)� of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
WA State License #/Exp. Date:
City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK:
no C)
PROPOSED NEW SQUARI-!�, F
OTAGE FOR THIS PROJECT:
Basement: �Zn ft
I" Floor: sq. ft.
Select BasementType: Finished Unfinished
Garage/ arpol-t: —sq. ft.
2"" Floor: sq. ft.
Bedrooms #_ Full-3/4 Bath # Half -Bath
Deck/Cvrd Porch/Patio: so- ft-
Other: sq. ft.
Retaini
Fire Sprinklers: Yes
F]
No
Grading: Cut cu. yds. Fill _CLI.Y(IS.
I Cut/Fill in Critical Area: Yes LJ No[_j
I declare underpenalty of perjury laws that the information I have provided on this formlapplication 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 Narne: Lc% Owner X Agent/Other 0 (specify):
U
D b
Signature, ate:
A
Y,
FORM A LABLIildiiig New Folder 2010\DONE & x-ferred to L-Building-New driveTorm A2014.docx Updated: 1/17/2014
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