APP AND PERMIT BLD20171250.pdfParcel No: 00473700002300
AARON ROSS
11006 NE 112TH
KIRKLAND, WA 98034
(425) 231-4548
TY OF
EDMONDS
121 5TH AVENUE NORTH - EDMONDS, W A 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
AARON ROSS
11006 NE 1 12TH
KIRKLAND, WA 98034
(425)231-4548
AARON ROSS
11006 NE 1 12TH
KIRKLAND, WA 98034'
(425)231-4548
VALUATION: ;$0
PERMIT TYPE: Residential PERMIT GROUP: 23 - Demolition
I
GRADING: N CYDS..O
TYPE OF CONSTRUCTION:
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
LOT #
BASEMENT: 0 1ST FLOOR: 0
2ND FLOOR. 0
BASEMENT: 0 1 ST FLOOR 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 _
OTHER: 0
3RD FLOOR: 0 GARAGE: 0... DECK 0 OTHER: 0
BEDROOMS 0 BATHROOMS. 0
BEDROOMS: 0 BATHROOMS:.0
REQUIRED: PROPOSED.
RE UIRED:
PROPOSED REQUIRED: PROPOSED,
HEIGHT ALLOWED:O PROPOSED.O
REQUIRED:
PROPOSED.
SETBACK NOTES:
APPROVALPERMIT
I AGREE TO`COMPLY WITH CITY AND STATE LAWS REGULATING' CONSTRUCTION AND IN DOING THE WORK 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.
TfJW APPLIZAZ12N IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISMER DEPUTY AND ALL FEES ARE PAID.
I4!�)-hrvr�qIlt'L
the Print Name Date' Released By Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY ABUILDING OR STRUCTURE' UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 'OR A CERTIFICATE OF
'OCCUPANCY HAS BEEN GRANTED UBC109/ IBCI 10/ IRC1 10„.
FIRE APPLICANT ASSESSOR CITY
�TUS: APPLIED
BLD20171250
• 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 foralternate 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 avariance 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 7:00amto 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 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 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)
BUILDINGENGINEERING425) 771-0220 EXT.1326
1. Go to: www.edmondswa.gov Building Department' Inspections
2. Then: Services are now scheduled online. If you FIRE (425) 775-7720
3. Then: Permits/Development have difficulties, please call the
,4, Then: Online Permit Info Building Department front desk for 'PUBLIC WORKS (425) 771-023,5
5: If you don't have one already, create a assistance during office hours.
login (upper right hand comer) (425) 771-0220 RECYCLING (425) 275.4801
6: Schedule your inspection
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
being re` uested, Contact Name and Phone Number Date Preferred„ and 'whether ou pEtfer momihg or afternoon,
• B-Preconstruction meeting
• B-Final Demolition
a' DEVELOPMENT SERVICES
" PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
t 121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 it Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, city St t t$11, Zip):
Parcel #:
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No ❑
APPLICANT:
Phone: Fax:
-
ya ''Jl
Address (Street, C"ity S1° „ � atc, Zi )"
6 6,
E-Mail Address:
21,5A
PROPER OWNE � ®
Phone: Fax:
Address NtKeet, City, State, Zip): I
E-Mail Address:
ENDI G AGENCY:
Phone: Fax:
A ens (Street, City, State, Zip):
E-Mail Address:
C l"+J ACTO :*
Phone: Fax:
Ackdress (Street, City, State, Zip):
E-Mail Address:
*Contractor
WA Statnse #/Exp. Date:
e 7A,
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
City Bus'ir ess 1.' ^cnse #/Exp. Date:
PLUMBING MECHANICAL TANK Lj
DEMOLITION
DETAIL THE SCOPE OF WORK
I declare under penalty of perjury laws 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: "* _ mm Owner �gent/Other
❑ (specify):._
..
Signature: . wM Date: lr • sit
FORM C L:\Building New Folder 2010\DONE & x-ferred to LrBuilding-New drive\Form C 2014.docx Updated: 1/17/2014
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORMI)
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to the City of Edmonds that:
❑ Value of work under $500.00. The aggregate contract price of labor and materials and all
other items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that lie/she is
a contractor, or that he/she is qualified to engage in the: business of contractor. RCW
18.27.090(9).
dr Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who l im/herself is not performing any activity of a.
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 1827.090(11).
Work performed personally on own,property. Anyone personally working on property
he/she owns, or at which lie/she resides, as long as the property owner, or resident:, does not
perform any, activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
❑ Use of own employees. Property owner using him/herself or his/her own employees to
perform maintenance, repair, and. alteration work in or upon his/her own property. RCW
18.27.090(13).
❑ Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating with the scope of his/her certification. RCW 18.72.090(14).
❑ Other. Specify which provision of RCW 18.27.090 applies:
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED. ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
0
DATED this day of � 20rL.
x
PROPERTY O)&NEReA11T1-IO1
PERSON,
Signature..
CC
Print Name
MINIMUM
Sign to
V1 �✓ tit .
Print Name
LATEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07