BLD20110415.pdfy OF EDMU �{�
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Expiration Date:
Parcel No: 00648100000300
Project Address: 9115 PARK RD
LANCE D & JULIE L HORTON LANCE D & JULIE L HORTON OWNER EXEMPTION
9115 PARK RD 9115 PARK RD
EDMONDS, WA 98026-7341 EDMONDS, WA 98026-7341
(425) 771-2927 EXT: (425) 771-2927 EXT: ( ) - EXT:
LICENSE #: EXP:
JOB DESCRIPTION
INSTALL NEW GAS FURNACE AND WATER HEATER LOCATED IN THE GARAGE. NEW GAS PIPING TO BOTH.
APPROX. 30 FEET
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
FENCE: N ( 0 X 0 FT.)
OTHER: N ------ OTHER DESC:
NUMBER OF STORIES: 0
OCCUPANT LOAD:
CODE: 09.
ZONE:
1 VESTED DATE: t A r
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
13 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK SIDE, SE-TBACK REAR SETBACK
REQUIRED: PROPOSED: I REQUIRED: PROPOSED: RE UIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O I REQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY,
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.
LS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
V �
Date
ATTENTION "
IT IS 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. UBC109/ IBC I 10/ IRC I 10.
ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUED
BLD20110415
• In addition to the required pressure/relief valve, an approved listed expansion tank shall be installed on all hot water tanks.
Per UPC 608.
• Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted.
• 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.
• SoundMoise 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 FIRE (425) 775-7720
PUBLIC WORKS 425) 771-0235 1 PRE-TREATMENT 425) 672-5755 1 RECYCLING 425) 275-4801
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 prefer morning or afternoon.
B -Gas Test/Pipe
• B -Mechanical Final
�y°F E°MInspection Comments
N BLD20110415 47 - Plumbing
Applied: 06/02/2011 Issued: 06/02/2011 Expires: 12/21/2011
Address: 9115 PARK RD, EDMONDS
INSPECTION _ DATE W INSPECTOR ACTION
1128 - B -Gas Test/Pipe 06/06/2011 STEINIKE CMP
Comment:
1156 - B -Mechanical Final
Comment:
12/20/2011 LAWLER CMP
12/21/2011 11:09:29 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1
EXEMPTION FROM 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:
❑ 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).
ff 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).
0 Work performed personally on own. property. Anyone personally working on property
he/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).
❑ Use of own employees. Propertyowner 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 within 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.
DATED this Z— day of „�k , 20j,�.
PROPERTY OWNER/AUTHORIZED
PE#CSON
Signature
LCA- V\, C4
Print Name
WITNESS
Si ature
Upt Ut
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07