4180_001.pdfov- BUILDING PERMIT
APPLICATION
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Development Services
Building Division
==01 121 Sth Ave N / Edmonds, WA 98020
�171)11 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: littp://w�vw.ediiiondswi.f,,ov/
JOB SITE INFORMATION�XCJAICIN: here? thq wpirkis king qlace)
Job Site Address:
Parcel:
Lot /Unit/Suite #
Subdivision:
PROPERTY OWNER'
Name:
MailingAddress:
City/State/Zip:
Phone#:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? 0 Yes 0 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:
APPLICANT / CONTACT l7t�TlqN(�.
Name of Applicant:
Mailing AddressA, 21
Citv/State/Zio: V L�
Phone
E-mail:
GENERAL CONTRACTOR: (if different from appficant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
CITY OF EDMONDS BUSINESS LICENSE M
Permit =#: BI
LA�>Z_M<e� 13TD 71
TYPE OF PERMIT (Provide
• Accessory Structure/
Detached Garage
Details on Page 2)
0 Addition
• Demolition
El M anica
El New Single Family / Duplex
Zplumbing
03 Fire -Sprinkler
Li Remodel
D New Commercial/ Mixed Use
Ll Re -Roof
El Signs
0 Tank
El Tenant Improvement
11 Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished 0 Unfinished 0
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
I certify that the information I have provided on this form/application 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 Name:
Signature: Date
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes El No El
WA STATE ENERGY CODE: If 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, firesprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas Elec Other QtY
A/C Unit /Compressor
Air Handier /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUMBING FIXTURE COUNTS (New, Relocated or re -piped)
City Qty
Clothes Washer
Tub/ 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 Line
Sinks
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re -piped)
QtY
QtY
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y/N PSCAA Case
Critical Areas Determination:
Study Required El Conditional Waiver El Waiver 11
Fill in Place El Fill Material:
Removal 0
Size of Tank (Gallons)
Critical Areas Determination:
Study Required El Conditional Waiver El Waiver 11
GRAD E/F1 LL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No El
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of I year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.
C,f Eb4f
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 10/22/2018 Perngt#: BLD20181380
BUILDING PERMIT
Expiration Date: 04/22/2019 ProjectAddress- 18902 84TH OR W, FDMONDS
Parcel No: 00434600002006
DAVID IRELAND
18902 84TH DR W
EDMONDS, WA 98020
STEVESPLUMBING
C/O STEVEN EGNER
2125 196TH
STEVES PLUMBING
CIO STEVEN EGNER
2125 196TH
LYNNWOOD, WA 98036 LYNNWOOD, WA 98036
(425) 422-3604 (425) 774-0483 (425) 774-0483
LICENSE #: STEVEP10040Z EXP:09/09/2020
JOB DLSCRIPTION
WATER SERVICE LINE
VALUATION: $0
PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE:
OTHER: ------- OTHER DESC:
ONE:
INUMBER OF ORIES: 0
VESTED DATE:
INUMBER OF DWELLING UNITS: 0
LOT #:
MS]ING ARLA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
P RO PO S ED AREA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR:
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
FRONTSETBACK SIDESETBACK REARSETBACK
REQUIRED: PROPOSED FREQUIRED: PROPOSED: -----7RE—QUIRED: PROPO_SED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO--CgMPLY WITHCRY ANDSTATELAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
PERSON WILL BF7-EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION
INSURANCE AND RCW 18:27.
N
T 154PPLICATIO J&J907A-PEITRT UNTIL SIGNED BY THE BUILDING OFFICIAJ.,OR HISMER DEPUTY AND ALL FEES ARE PAID.
naTu—tle- Print Name Date 1 '"1116reasbd Bj Da(e
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. UBC] 09/ IBCI 10/ IRCI 10.
FIRE APPLICANT = ASSIESSOR CITY
STATUS: ISSUED
BLD20181380
• City approved plastic piping rnay be used in water service piping provided that where metal water service piping is used for
electrical grounding purposes, replacement piping shall be of like materials (UPC 604.8). A state electrical permit and
inspection is required if electrical grounding is altered, removed, improved, or added. Contact State Dept. of Labor &
Industries Electrical Division at 425-290-1400.
• Final approval on a project or final occupancy approval must be granted by the Building Official priorto use or occupancy of
the brifiding 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 orpolicies 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 terTorary construction sites as a result of construction activity are exempt from the noise lirnits
of ECC Chapter 5.30 only during the hours of 7:00am to 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 lirnits 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 firomany and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance for this pennit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor lin-fit in any way the City's ability to enforce any ordinance
provision.
• Owner/Contractor to provide Water Service Line asbuilt at final inspection. See City Standards for requirements.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMITCOVERS WORK TO BE DONE ON PRKIATE 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
1. Go to: www.edmondswa.gov
Building Department Inspections
2. Then: Ser\Aces
are now scheduled online. If you
3. Then: Perm its/Development
have difficulties, please call the
4. Then: Online Permit Info
Building Department front desk for
5: If you don't haw one already, create a assistance during office hours
login (upper right hand corner) (425) 771-0220
6: Schedule your inspection
ENGINEERING (425) 771-0220 EXT. 1326
� FIRE (425) 775-7720
� PUBLIC WORKS (425) 771-0235
RECYCLING (425) 275-4801
When calling for an inspection please leaw the following information: Permit Number, Job Site Address, Type of Inspection
being requested, Contact Name and Phone Number, Date Preferred, and whether you prefer morning or afternoon.
• E-Water Service Line
• B-Plun-bing Final