20170615083517.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 06/15/2017 Permit-4: BLD20170-793
BITILDING' PERMIT
Expiration Date: 12/15/2017 ProJecii Wdress: 760 ELM ST, EDMONDS
Parcel No: 00531200000100
LIVING TRUST SAGLAND
HILLSIDE ROOFING& GUTTERS INC
HILLSIDE ROOFING& GUTTERS INC
760 ELM ST
CIO GREGORY (]USTELIUS
C/O GREGORY GUSTELIUS
EDMONDS, WA 98020
16513 A HWY 99
16513 A HWY 99
LYNNWOOD, WA 98037
LYNNWOOD, WA 98037
(425) 774-6069
(206) 362-7663
(206) 362-7663
LICENSE# lullsraWltc EXP:06/21/2017
I Ma,
,I Relf)
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 54 - Re-Roof/RoofAlter/Repair
GRADING: N CYDS: 0
TYPE OF CO STRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: OXO FT)
CODE: 2015
OTHER: ------- OTHERDESC:
IZONE
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
3 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
FrR
FRONT S FYR A('K
IREQUIRED7 PROPOSED: ]REQUIRED:
swEsFrBAUK REA 11 S A('k
PROPOSED: MQ71JIRED: PROPOSED:
1HEIGHT ALLO ED:O PROPOSED:O
IREQUIRED: PROPOSED:
[SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT ING 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
T litTARP [ACATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISIHER DEPUTY AND ALL FEES ARE PAID
1 0/7
DA,�j :, 70h4i 6/1'5-121
o 5/( -2 khStl� L I
SignafTre Print Name Date Released 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. UBCI09/IBCII0/ IRCIIO.
ONLINE APPLICANT = ASSESSOR S2� OTHER
STATUS: ISSUED BLD20170793
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. Check the job card for all required City inspections including fin a] project approval and fin a]
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 con ' struction 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 fi7om 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 indemnify defend and hold
harmless 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.
PERMITTIME LIMIT. SEE ECDC 19.00.005(A)(6)
I BUILDING (425) 771-0220 EXT. 1333 1 ENGINIMIING (425) 771-0220 EXT. 1326 1 FME (425) 775-7720 1
I PUBUC WORKS (425) 771-0235 1 PR&TREATMENT (425) 672-5755 1 RECYCILING (425) 2754801 1
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 Prefereed, and mbether you prefer morning or afternoon.
• B-Roof Tear Off
• B-Building Final
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
". 1 1. 199 1215 1h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 9 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
760 C-LAA 20MOW03 �./A
Parcel #:
Subdivision/Lot #: 4��LO
Project Valuation: $
APPLICANT:
L'us I OL5. 7_00 �-(p 6 A e -
Phone:
U6 47- - I 1�& S
Fax:
I 7-2, - -714 -3 - L4 10 Q
Address (Street, City, State, Zip):
k (CS ('� kAkV4 1:!� L_LiHMV_,U,P,WA ftovl
E-Mail Address:
CA ct .5, aup-.0)4, �n4f
PROPERTY OWNER:
At D&- <S;AeL__ANs�)
Phone:
'11S-77-1- &00!�
Fax: 1J
Address (Street, City, State, Zip):
-)6.0 L>LA^ �9-,r 2�OA400QS w/k 11OU
E-Mail Address:
_F777-
LENDING AGENCY:
Phone:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
0a CZ00 v ( t-� A 6 Or naLs
Phone:
7oto -3 (at , 0 1
FFa x
Z�:
qzs 9 - -(f 0()
Address (Street, City, State, Zip):
1�4SJ3 ��JA$IWOiV)4 WA 13SO-LO
E-Mail Address:
aalq
*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:�J
SP-C * 14 1 LL-S N & 0 2- 1 L-C
City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK: o 6 C LA C01A A 0- t�T - 60,11 too 5", 1r/1 I Li
PROPOSED NEW SQUARE F
OTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished L_J Unfinished [-I
1" Floor: sq. ft.
Garage/Carport: sq. ft.
2 "d Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: scl.
Fire Sprinklers: Yes
L]
No [-I
Retaining Wall: Yes L]
No
Ll
Grading: Cut —cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes LJ No D
Ideclare under penalty ofperjury laws that the information I have provided on this formlapplication istrue, correctand
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: -DAy,1 so�n4 OwnerEl Agent/Other M (specify): � 4'_nAl'
Signature: U S��. Date:—b �_Lsl --�
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014