20180709154110.pdfCITY OF EDMONDS
I2I 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX: (a25) 771-0221¿c. l8
STATUS: ISSUED 07 109n0ß Permit #: 8LD201.80937
BTIILDING PERMIT
Expiration Date : 0l/09 /2019 Project Address: 20901 WOODLAKE DR, EDMONDS
Parcel No: 0063770000 I I 00
PROPm.TYOWNm CONTRACTORAPPLICANT
BRIAN P BERGSTROM
2O9OI WOODLAKE DR
EDMONDS, WA 98026
The Heat and AC Guys
C/O John Archer
5016 208rh sr sw
Lynnwood, WA 98036
(42s) s82-1200
The Heat and AC Guys
C/O John Archer
50 I 6 208rh St SW
Lynnuood, WA 98036
(42s) s82-'7200
LICENSE #: HEATAHA842PD EXP:10/04/2018
JOB DESCRIPTION
l€working gas piping to existing appliances for gas meter relocate.
VALUATION: $0
PERMIT GROUP: 47 - PlumbinePERMIT TYPE: Residential
GRADING: N CYDS: O TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY:OCCUPANT GROUP
OCCUPANT LOAD
FENCE ( OXO FT)CODE:
OTHER: ------- OTHER DESC:ZONE:
VESTED DATENIIMBER OF STORIES: 0
NUMBER OF DWELLINGUNITS: 0
2ND FLOOR: 0BASEMENT:O IST FLOOR:0 IST FLOOR:0 2ND FLOOR: 0
LOT #
BASEMENT:O
3RD FLOOR:0 GARAGE:0 DECK:0 OTHER:0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS:0 BATHROOMS:0BEDROOMS:0 BATHROOMS:0
I'(ISTING ARI'A PRO POSED ARIìA
REQUIRED: PROPOSED REQUIRED: PROPOSED:REQUIRED: PROPOSED
HEIGHT ALLOWED:0 PROPOSED:0 REQUIRED: PROPOSED:
SETBACK NOTES:
FRONTSETBACK SIDESETBACK REARSUTBACK
IAGREE TO COMP-Y WTH CtÏY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORZED THEREBY, NO
PERSON WILL BE EMH.OYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RB-ATING TO WORKMEN'S COMPENSAÏON
INSURANCE AND RCW 1 8:27.
NOT A PERMII UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
PERMIT APPROVAL
Ðøni¡a Naßon Juty e,2018
Ðint Nane Date
ATTENTION
Released By
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCI O9l IBCI I O/ IRCl IO,
Date
FIRE APPLICANT ASSESSOR CITY
CONDITIONS
STATUS: ISSUED 8LD20180937
¡ Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.. Final approval on a ploject or final occupancy approval must be granted by the Building Official prior to use ot' occupancy of
the building or structure. Checkthe job card for all required City inspections including final project approval and final
occupancy inspections.
. Any request for altetnate design, modification, variance or other administrative deviation (hercinafter "variance") fi'om
adopted codes, ordinances or policies must be specificalþ requested in writing and be called out and identified. Processino
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 provis ions which do not compþ with city code and for which a variance has not been
specificalþ identified, requested and considered by the appropriate cify ofücial in accordance with the appropriate provision
of city code or state law does not approve any items not to code specifìcation.
Sound/\loise originating fromtemporary construction sites as a result of construction activity are ercmpt fiomthe 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 othertimes the noise originating fromconstruction 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 ûom any and all claims for damages of
whatevernature, arising directþ orindirectþ fiomthe issuance forthis permit. Issuance ofthis permit shallnot 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 FERMTTAUTHORIZ ES ONLY THEWORK NOTED. THIS FERMII COVERS WORK TO BE DONE ON FRIVATE FROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDÉWALKS, DRIVËWAYS, MARQUEES, ETC.) WLL REQUIRE SEPARATE PERMISSION. FERMII
TIME LlMlr: SEE ECDC 1 9.00.005(A)(6)
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INSPtr'TIONS
TO S(]HEDULE INS PECTIONS
BUILDING ENGINEERTNG (425) 7714220 EXT. 1326
1. Go to: \ivww.edmondswa.gov
2. Then: Senices
3. Then: Permits/Delelopment
4. Then: Online Permit lnfo
5: lf you don't haw one already, create a
login (upper right hand corner)
6: Schedule Vour inspection
Building Department lnspections
are now scheduled online. lf you
hale dificulties, please call the
Building Department front desk for
assistance during offce hours.
(425) 771-0220
FIRE (425) 775-7720
PUBLIC WORKS (4251 77 1 4235
RECYCLI NG (4251 27 54801
When calling for an inspection please leale the following information: Permit Number, Job Site Address, Type of lnspection
Contact Name and Phone Number Date and whether or afrernoon.
B-Gas Test/Pipe
B-Plumbing Final
ac. I
BUITDING PERMIT
APPTICATION
Developmenl Services
Building Divlsion
l2l sth Ave N / Edmonds, WA 98020
425.771.0220
; For handouts, submittal requirements, perm¡t status and inspection
'r schedulinginformation goto:@
JOB SITE INFORMATION/LOCATION: (where the work is taking place)
JobSiteAddress: Z i' ' q¿r<UA'D{L
Parcel
Lot /Unit/Suite #:
-
Subdivision
PROPERTY OWNER:
Name:d
Mailing Address:
CitV/statelZip:
Phone #
Email
OWNER INSTALIATION: *lf yes, read and sign*
Will work be performed by the property owner? tr Yes ! No
I own, reside in, or will reside in the completed structure.
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPTICANT /CONTACT INFORMATION:
Name of Applicant
Mailing Address:
city/state/zip
Phone #:
E-mail:
GENERAT CONTRACIOR: (lf d from applicantl
General Contractor:
Mailing Address:
ciry/state/zi
Phone #:
E-mail
wA srATE CONTRACTOR t & lS (CCB) & EXPIRATION DATE:
Permil #
')flice Use ,lnlr
tr Additiontr AccessoryStructure/
Detached Garage
tr Mechanicaltr Demolition
! New Single Family / Duplex tr Plumbing
tr Remodeltr Fire Sprinkler
D Re-Rooftr New Commercial/ Mixed Use
tl Tank! Signs
Á*",&9!tpgD Tenant lmprovement
Remodel Permll fees ore bosed on:
The volue of lhe work performed. lndicofe the volue (rounded to
the neorest dollor) of oll equipment, moteriols, lobor, overheod,
ond the profit for the workindicoted on this opplicotion.
Voluolion:
Finished tr Unfinished DBasement sq ft:
lst Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio
sq ft:
I certify that the information I have provided on this form/appl¡cation is true,
correct and complete, and that I am the property owner or duly authorized
agent of the property owner to subm¡t a permit application to the City oftPrint
S¡gnature:
Edmonds.
TYPE OF PERMII (Provide Detoils on Poge 2)
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
PROJECT DESCRIPTION
CITY OF EDMONDS BUSINESS LICENSE f:
¿@/u,
Occupancy Group(s)Occupant Load(s)
Type(s) of Construction Fire Sprinklers: Yes ! No !
WA STATE ENERGY CODE: lf your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
perm¡ts are applied for separately.
Tl / CHANGE OF USE / NEW BLDG: tnclude TRAFFTC tMpACT worksheet
BTUS cas / Elec / Other ety
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
Qtv Qtv
Clothes Washer lub/ Showers
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain Pressure Reduction/ Regulator Valve
Floor Drain/Sink Refrigerator Water Supply
Hose Bibs Water Heater -Tankless? Y or N
Hydronic Heat Water Service L¡ne
Sinks Other:
Toilets Other:
GENERAL COMMERCIAL DATA
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
PLUMBING FIXTURE COUNTS (New, Relocated or re-piped)
BTUS Qty BTUs Qty
A/c Unit oÈa€{Wfu"pn {
Boiler ï";vúftl6"kþ
Dryer *måTfc,
Fireplace/ lnsert Other:
,u?"#%e ì Other:
-4vL8a{¿-
Y.->)o<¿rtz I
Qtv Qtv
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medical - Surgical Vacuum
Type of structure to be demolished:
Other:
Square footage of structure to be demolished:
AHERA Surveydone? Y/N PSCAA Case #:
Critical Areas Determination:
Study Required E Conditional Waiver E Waiver fl
Fill in Place E Fill Material
Removal fl Size of Tank (Gallons)
Critical Areas Determination:
Study Required E Conditional Waiver E Waiver fl
Grading: Cut cubic yards
Fiil cubic yards
Cut / Fill in Critical Area: Yes E No E
APPLICATIONS: Applications are valid for a maximum of 1 year
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & lndustries and have a
current City of Edmonds Business L¡cense.
GAS/FUEL CONNECTTON COUNTS (New, Relocated or re-piped)
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re-piped)
DEMOLITION
TANK
GRADE/FILL/EXCAVATE
GENERAL PROVISIONS