4669_001.pdfo
CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 12/05/2018 Pennit #: BLD20181572
BUILDING PERMIT
Expiration Date: 0611005111200"t 971? Pkvjed Address: 9024 191 ST PL SW, EDMONDS
Parcel No: 00434600003003
PROPERTVOWNLR
APPLICANT
KRISTAM & ZANIS MICHAEL NICHOLS
EDUARDO ZAMBRANO
EDCA INC
9024 191ST PL SW
10 16 INDUSTRY DRIVE
CIO EDUARDO ZAMBRANO
EDMONDS, WA 98026-5944
TUKWILA, WA 98188
10 16 INDUSTRY DRIVE
TUKWILA,WA 99199
(765) 5 86-186 5
(2 06) 972-54 82
(206) 792-7294
LICENSE #: EDCAI* " 26RT EXP:O 1/06/2019
JOB DESCRIPTION
TEAR OFF, REPLACE ROOF
VALUATION: $0
PERMIT TYPE: Rcsidential
PERMIT GR UP: 54 - Re-Roof/Roof Altei /Repair
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION
RETAINING WALL ROCKERY
OCCUPANT GROUP
OCCUPANT OAD
FENCE: 0 X 0 FT
CODE
OTHER: ------- OTHER DESC
ZONE:
,NUMBER OF S ORIES: 0
FVEST ED DATE
INUMBER OF DWELLINGUNITS 0
ILOT #:
M,.STINGAREA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PRO 110 S ED AREA
ASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR 0 GARAGE: 0 DECK: 0 OTHER 0
FLOOR: 0 GA RAGE: 0 DECK: 0 OTHER 0
BEDROOMS: 0 BATHROOMS: 0
IBEDROOMS: 0 BATHROOMS: 0
FRONT S ErB ACK SIDESETBACK REARSETBACK
REQUIRED: PROPOSED: ��REQUIRED PROPOSED: �REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED 0 IREQUIRED: PROPOSED
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THEWORK 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.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
1-104,, 12/5/18
Signature Print
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/ IBCI 10/ IRC 110.
= FIRE = APPLICANT = ASSESSOR = CITY
STATUS: ISSUED BLD20181572
CONDITIONS
• Final approval on a projector fin a] occupancy approval must be granted by the Building Official prior to use or occupancy of
the build in g or structure. Check the job card for all required City inspections including fin a] project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (bereinatler "variance") from
adopted codes, ordinances or policies must be specifically requested in wtiting 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 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 from the 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.
INS PECTIONS
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, SIDBNALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT
TIME LIMIT: SEE ECDC 19.00.005(A) (6)
I TO SCHEDULE INSPECTIONS
BUILDING
j 1. Go to: www.edmondswa.gov
2. Then: SeNces
3. Then: Perm its/Devel opment
4. Then: Online Permit Info
5: If you don't have one already, create a
login (upper right hand corner)
L6-s—c—hedule-Y
Building Department Inspections
are now scheduled online. If you
have difficulties, please call the
Building Department front desk for
assistance during office hours.
(425) 771-0220
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 leave 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.
• B-Roof Tear Off
• B-Building Final
BUILDING PERMIT Office Use Only
APPLICATION Permit #.
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
'11c. isk)" 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: http://www.edmondswa.gov
JOB SITE INFORMATION/LOCATION: here the work Is taking place)
JobSiteAddress: q0A 1q, Q te- 5'. �j
V_T V U U %j U
(- ""3q6
Parcel: 2
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: �"CNNO\C., Kv\�_fci
Mailing Address: �(),aq 1 q ) c_*1 pt ,,,ce_ S
City/State/Zip: CA V-1 o,% �s �A)pll. qS6�f�
Phone#: 1 765-5�6 1?6
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 INFORMATION:
Name of Applicant: E-joctw-A-0 �Ictk4b-a�"'p
MailingAddress: 101� Xq&±" D'r,je-
City/State/Zip7LLAk_Lj_.) 6i �k'
)p
Phone #: '�OG 9'�,a Sq 8 2
E-mail: eA%jCtV40
GENERAL CONTRACTOR: (if different from applicant)
General Contractor: E (� c,� -1 "lloc-
Mailing Address: 10(6 T'�L§�V�A I)r-,Lje-
City/State/Zip'--_Tq K U_� A a . to r+, q 8 e
Phone #: 20G -1`i6a -79 9q
E-mail: If koc-kc C�D P e_jcck V'004�% -V\ 5. CO-1
WA STATE CONTRACT9 L & I # [CCB) & EXPIR TIT DATE:
Eb C -A -1 "� I a G � '1 76 01019
OVS
CITY OF EDMONDS BUSINESS LICENSE #: 'L/d(__(o
TYPE OF PERMIT (Provide Details on Page 2)
• Accessory Structure/ El Addition
Detached Garage
• Demolition
0 Mechanical
• New Single Family / Duplex
El Fire Sprinkler
El Plumbing
El Remodel
lj� Re -Roof
El New Commercial/ Mixed Use
0 Signs
0 Tank
El Tenant Improvement 0 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 jor the work indicated on this application.
Valuation: 0,- C) D
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished El Unfinished El
ist Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
other sq ft:
PROJECT DESCRIPTION
()�XC CkCA.�-C4��
IV -Coe.
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: E&r)o,-L 2 c4 ti 6
Signature: � �'/ — Datell-1-03-19
Y-1
FIP'