20170321131434.pdfCITY OF EDMONDS
121 5TH AVENTUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 03/21/2017 Permit 9-: BLD21017,0386
BUILDING PERMIT
Expiration Date: 09/21/2017 ProjectAddress: 21424 95TI-1 PL \A7, EDMONDS
Parcel No: 00528100001500
CHRISTOPHER M & MICHOLE I MATTIX
CHRISTOPHER M & MICHOLE J
CHRISTOPHER M & MICHOLE J MATTIX
21424 95TH PL W
MATTIX
21424 95TH PL W
EDMONDS, WA 98020-3318
21424 95TH PL W
EDMONDS, WA 98020-3318
EDMONDS, WA 98020-3318
(425) 771-5651
(425) 771-5651
(425) 771-5651
LICENSE #: EXP:
REPLACE 9 WINDOWS SLIDER DOOR, REPLACE PICTURE WINDOW W/ DOUBLE FRENCH DOORS.
WORK PERMFORMED PRIOR TO PERMIT.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 43 - Miscellaneous
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY:
OCCUPANT GROUP
OCCUPANT LOAD
FENCE: OXO FT
CODE: 2015
OTHER: ------- OTHER DESC:
[ZONE:
I 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
FRONTSETBACK SIDESETBACK REAR SETBACK
REQUIRED: PROPOSED: -7REQUIRED: PROPOSED: =REQUIRED� PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE 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.
1S/1'l14MWJMe.S N( I A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID
0312-11-z'017
Sidnature Print Name Dafe Released W 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 UBC]09/IBCIIO/IRC110
ONLINE APPLICANT ASSESSOR OTIIER
STATUS: ISSUED BLD20170386
CONDITIONS
• 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. Checkthejob 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 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 7:00am to 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 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 inden-mify defend and hold
hanriless the City of Edmonds, Washington, its officials, employees, and agents from any and all claim 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.
1333
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
EXT. 1326
PUBLIC WORKS (425) 771-0235 PR&TREATNIENT (425) 672-5755 RECYCLING (425) 2754801
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 mbether vou m-efer mornine or afternoon.
• B-Window Flashing
• B-Wall Insulation/Caulk
• B-Building Final
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
1215 1h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 It Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDREIS (Street, Suite #, (Aly State Zip)-
DW-0-4 PL-,L wA
930to
Parcel #:
Subdivision/Lot
Project Valuation: $
APPLICANT:
CANr, S- ma-;�4 i Y,
P�one:
�' I
Fax:
I
Address (Street, City State Zip)-
2-14 ZA_ CL �� k �L V*J F_A+"vJs WA %Jtb
E-Mail dress: g
v\_ aAV1 I )c e_ V-A " ' I -
PROPERTY OWNER:
C--"b (- k:5 mzft 1)"
Phqng: IMP
(A Z5-_?� 1-565 1
Fax:
1
Address (Streqt, City, Str, Zip):
q �54 el �q
-2-14 2- LA 5
E-Mail Address:
LENDING AGENCY:
Pbo
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* 0 Lr,
Phone:
Fax:
Address (Street, City, State, Zip):
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 #/Exp. Date:
City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK: Pce
dow,Laaet�L VlKdo klAii,stA R!c-AV1rc
W I q\ Jaws; (a(LkM.'n- L-,/
w,,1W 1 A-Ar lLhL fi?_,kcAn L(r,
VCL LAL OLIUIWIA.W�,
Vill,!,/ sl�
PROPOSED NEW SQUARE F
OTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished LJ Unfinished Ll
1 " Floor: sq. ft.
Garage/Carport: sq. ft.
27 Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes L]
No 0
—1
1 Retaining W 1: Yes [_
No
Ll
Grading: Cut —cu. yds. Fill cu.yds.
I Cut/Fill in Critical Area: Yes LJ No
I declare under penalty ofpeijury laws that the information I have provided on this formlapplication is true, correct and
complete, and that I am the property owner or duty authorized agent of the property owner to submit a permit application to
the City of Edmonds.
Print Name: Owner P9 Agent/OtherEl (specify):
Signature: Date:_;�/�_/ 12
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New, drive\Form A2014.docx Updated: 1/17/2014
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:
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).
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
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
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).
Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
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 HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this ��- � day of k--�ftVC�k— 2(LJ1
PROPERTY OWNER/AUTHORIZED
PE
Signature
A14,
Print Nai-ne
WITNESS
—"\r\ �\—Q
Signature
Print Naine
LATFMP\[3UILD1NG\Hand0L1t ArchivesWANDOUTS REVISED IN 2009\PREVIOUS HANDOUI'S\FORMS\CONTRACTOR EXEMPTION
FORM D.DOCREVISED 7/07