BLD20110283.pdfSTATUS: ISSUED 4/21/2011
Expiration Date: 4/21/2012
Parcel No: 27041900110600
CITY OF EDMONDS
1215TH AVENUE NORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Permit #: BLD20.1.10283-
Project Address: 20222 76TH AVE W, EDMONDS,
EDGEWOOD BAPTIST CHURCH LEIF BJORBACK PROPERTY OWNER EXEMPTION TAKEN
20406 76TH AVE W 6126 185TH ST SW
EDMONDS, WA 98026- LYNNWOOD, WA 98037-
( ) - Ext. (425) 776-5104 Ext. ( ) - Est.
LICENSE #: EXP:
DESCRIPTIONJOB
RELOCATE RETURN AIR DUCTWORK FROM CRAWL SPACE TO ATTIC. ADD FOUNDATION VENTS TO UNVENTED CRAWL
SPACE.
VALUATION: $500
PERMIT TYPE: Residential
PERMIT GROUP 04 - Alteration/Remodel Interior
GRADING: N CYDS: 0
TYPF OF CONSTRUCTION: VB
RETAINING WALL ROCKERY: N
OCCUPANT GROUP: R3
FENCE: N ( 0 X 0 FT.)
OTHER: N ------- OTHER DESC:
NUMBER OF STORIES: 0
OCCUPANT LOAD: Aft Aft W W WAk Of NW
CODE: 2009
"LONE:
VESI'ED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1 S -r FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 ISI' FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
LEQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
1EIGHT ALLOWE.•D:0 PROPOSED REQUIREDPROPOSED
;ETBACK NOTES:
1 AGREE TO COMPLY WITH CITY AND SPATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE 01 -THE STATE OF WASHINGTON REL,ATINGTO
WORKMEN'SCOMPENSATION INSURANCE AND RCW 18:27.
THISAPPLICATION IS NOT A PERMIT UNTIL. SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEESARE PAID.
J \ I// - . \ A — � . 1 ___r7.1
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ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY ABU I L DING OR STRUCRJRE UNTIL A FINAL. INSPECIION HAS BEEN MADE AND APPROVAL ORA CERTIFICATT:OF
OCCUVANCI• IIAS BEEN GRANTED. UBC 109/ 113C 10/ IRCI 10.
ONLINE = APPLICANT = ASSESSOR OTHER
STATUS: ISSUED
BLD20110283
• Final approval on a project or 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 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 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 10:00am 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 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.
PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 EIRE(425) 775-7720
PUBLIC WORKS (425)771-0235 1 PRF,'IREATMENT 425 672-5755 1 RECYCLING 425 2754801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
. reauested. Contact Name and Phone Number. Date Prefereed. and whether you Drefer mornine or afternoon.
• B -Mechanical Rough In
• B -Building Final
�',�V E°'" Inspection Comments
BLD20110283 04 - Alteration/Remodel Interior
Applied: 04/21/2011 Issued: 04/21/2011 Expires: 04/21/2012
Address: 20222 76TH AVE W, EDMONDS
INSPECTION DATE INSPECTOR ACTION
1130 - B -Mechanical Rough In 08/25/2011 LAWLER CMP
Comment:
1158 - B -Building Final 08/25/2011 LAWLER CMP
Comment:
11/29/2011 9:59:02 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1
EXEMPTION FRO1V1''CONTRACTOR
REGISTRATION 'VERIFICATION
FORM D
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:
O 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 he/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090(9).
O Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who him/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 18.27.090(11).
Work performed personally on own property: Anyone personally working on property
e/she owns, or at which he/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).
O 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).
O 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 within the scope of his/her certification. RCW 18.72.090(14).
O 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.
DATED this l day of , 20�
PROPERTY OWNER/AUTHORIZED
PERSON �.
i
Signatu
Print Name
REVISED 7/07