20170605153439.pdf0 1: E 1) it,
CITY OF EDMONDS
PHONE: (425) 771-0220 - FAX: (425) 771-0221
121 5TH AVENUE NORTH -EDMONDS, WA 98020
/'7 C. 'g
STATUS: ISSUED 06/05/2017
Expiration Date: 12/05/2017
Parcel No: 00544600001002
CHIP FROHLICH NGB ROOFING NGB ROOFING
20625 88TH AVE W C/O NIKOLAY BAGOSHVILI C/O NIKOLAY BAGOSHVILI
EDMONDS, WA 98026-6656 19215 80TH PL W 19215 80TH PL W
EDMONDS, WA 98026 EDMONDS, WA 98026
(206) 919-1180 (206) 883-6232 (206) 883-6232
LICENSE #: NGBROR*889M7 EXP:07/30/2018
TEAR OFF EXISTING SHINGLE ROOF, REPLA CE ANY DAMAGED PLYWOOD. REPLA CE W/ 30 YEAR ARCH SHINGLES.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 54 - Re-Roof/Roof Alter/Repair
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:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
I
LOT 4:
RvlhmmINK�
BASEMENT - 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PRD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR 0 GARAGE: 0 DECK: 0 OTHER -
[BEDROOMS: 0 BATHROOMS: 0
11BEDROOMS: 0 BATHROOMS: 0 �777d
FRONTSFrBACK SIDESFMACK REAR SETBACK
REQUIRED: PROPOSED: :1—EQUIRED: PROPOSED. FTU: I R E D: 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 RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27
THIS APPLIC�AvT- ION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HlSflll:l� DEPUTY AND ALL FEES ARE PAID.
Signature Print Name V Date
Released By
ATTENTION
IT IS 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 C7;� OTBER
F
STATUS: ISSUED BLD20170751
• 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.
• 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 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 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 fromthe issuance for this permit. 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)
BUILDING (425) 771
FIRE (425) 775-7720
PUBUC WORKS (425) 771-0235 PRE-TREATMENT (425) 672-5755 RECYCLJNG (425) 2 5480 �]
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 whether vou mefer morninp- or afternoon.
• B-Roof Tear Off
• B-Building Final
0 0
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5'h 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 ADDRESS Street, �uite #, City State, Zip):
I
ym
Parcel #:
Subdivision/Lot #:
Project Valuation: $ / 4YI 4ao
APPLICANT: /�//M AVeAwIlyc
Phone-.,�W , 4Fax:
A,odress (S Cit S ate, Zk1i:
E-Mail Address: 41
PROP. RTY OWNER-
CV0 F^9 A. // a04
Phone:
Fax."
Address'(Street, City, State, Zip):
,24"�06--
IQ=
E-Mail Address-
51 d161 A�Wll 59� C P/—*?
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:
Phone,
Fax:
Address Street, C* S te, Zi
Ay, R A-/ I rollml',V�5
E-Mail Address:
411 bA A
*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 WExp. Date:
_,61?tM"Fflf 7/14 7
Li ,CJf/Exp. Date:
City 5usiness leens
DETAIL7IE SCOPE OF WORK: 7_g4w
to�b 0 dlA V —7x-4A. 4 ot�
k ew __ WeCA
.51c' ale, zw
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished Ll Unfinished LJ
I" Floor: sq. ft.
Garage/Carport: —sq. ft.
2"Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: —sq. ft.
Fire Sprinklers: Yes
LJ
NoE]
Retaining Wall: Yes
No
Grading: Cut cu. yds. Fill —cu.yds.
Cut/Fill in Critical Area: Yes L] No
I declare underpenalty ofperjury laws that the information I have provided on this formlapplication is true, correct and
complete, and that I am the properly owner or duly authorized agent of the property owner to submit a permit application to
the City of Edmonds.
Print Name: /// bA era //1/11 OwnerEj Agent/OlherM (specify):
Signature: Date:
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014