BLD20110541.pdfof ED-Af
CITY OF EDMONDS
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121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 8/9/2011
Expiration Date: 2/9/2012
Parcel No: 00456000000900
MICHAEL J WEISMAN MICHAEL J WEISMAN HOMEOWNER EXEMPTION TAKEN
5016 6TH AVE NW 5016 6TH AVE NW
SEATTLE, WA 98107 SEATTLE, WA 98107
(206) 353-7630 EXT: (206) 353-7630 EXT: ( ) - EXT:
LICENSE #: EXP:
DEMO 3600 SQ. FT. FIRE DAMAGED HOUSE.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 23 - Demolition
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: N ( 0 X 0 FT.)
CODE: 09
OTHER: N ----- OTHER DESC:
ZONE: RS -12
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0 Emu=
I LOT #: MCMMMMEW
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK SIDE, SETBACK REAR SE.TBACK
.E UIRED: N 25 PROPOSED: I REQUIRED: W 10 PROPOSED: [REQUIRED: E 25 PROPOSED:
[EIGHT ALLOWED:25 PROPOSED:O RE UIRED: S 10 PROPOSED:
ETBACK NOTES: Platted prior to annexation in 1963
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.
IS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ,44L FEES ARE PAID.
Signature
me
Released By
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 110/ IRC 110.
= ONLINE = APPLICANT = ASSESSOR ® OTHER
STATUS: ISSUED " BLD20110541
CONDITIONS
• A CONDITION OF COMPLETION FOR THE DEMOLITION WORK WILL BE A RENDERING OF PROPERTY TO A
SAFE CONDITION THAT AVOIDS AN ATTRACTIVE NUISANCE OR STATE OF PUBLIC HAZARD.
• Critical areas shall be protected during demolition using erosion and sediment control established through ECDC 18.30.
• *Pre -inspection required.
• *Street to be cleaned of debris.
• *Side sewer must be capped at property line.
• *Water Service must be disconnected from Water meter and or hose bib with AVB installed.
• *Dump at approved dump site only.
• *See demolition inspection checklist on back of job card for inspection requirements.
• 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.
• Request final Fire Department Inspection (425) 775-0215.
• Call for locates of underground utilities prior to any excavation.
• Maintain erosion & sedimentation control per city standards.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
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
beine requested. Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
• E -Pre -Demolition Sewer Cap
• E -Pre -Demo Water Sery Discnct/AVB
• E -Pre -Demo Erosion Control
• E -Engineering Final Demo
• B -Final Demolition
• F -Fire Compliance
10/20/2011 15:01 FAX 3602364719
HPQA6-LEGAL/INVEST
Construction Prow
Z001/001
City of Edmonds 121 5th Ave N Edmon 4�w 15 eYL- y
Call 24 hours in advance for inspec
B -building: (425) 771-0220 ext 1333 F - fire: (425)
E -engineering: (425) 771-0220 ext 1326 P - planning: (425) 771-0220
Project: DEMO 3600.SQ. FT. FIRE DAMAGED HOUSE.
Permit #: BLD20110541
Project Address: 1.7500 72ND AVE W, EDMONDS
Parcel #: 00456000000900
Owner: MICHARL WF,ISMAN
Contractor: TRD
Lender:
5016 6TH AVE NW
pp
not
Discnct/AVB
SEATTLE. WA 98107
LICENSE 0: EXP:
E-Pre-Dcmo Erosion Control
Construction (tours are lam - 6prn on weekdays, 10arn - 6prn Saturdays.
INSPECTION,
INSPECTOR
DATE - COMMENTS
E-Prc.Dcmolition Scwcr Cap
E -Pre -Demo Water Serv-
pp
not
Discnct/AVB
E-Pre-Dcmo Erosion Control
E -Engineering Final Demo�d
OILleg V
o,
Demolition Inspection Checklist
Refer to City Demolition Permit Handout for specific requirements..
Prior to Start of Demolition Work
I. Call SCAR (Puret Sound Cle%jj Air AeencY)_206-M3-8800
regarding asbestos abatement or go to http://www.pscleanair.orgi.
2. Call Eneinetrinrt laspect r for PraDemolltlom Inspectiou14251
771-0220 ext 1336.-
• The Engineering Inspector will verify that:
A. Sanitary sewer line is capped at the property line.
B, Water service line is capped and has an approvod hose bib
with AVB to be used for dust control.
C. Barricades, signage or other measures installed for
pedestrian safety when applicable.
D. Erosion control measures are in place.
3. Call Building Inspector for Pra-D o
771-0;20 e><t 1331
• The Building Inspector will verify that:
A. All the utilities (power, gas, phone, TV cable) have been
properly disconnected.
During Demolition the Contractor/Owner Must
i. Keep streets clean of debris.
2. Maintain dust control.
3. Work within permitted construction hours of 7:00am -
6:OOpm weekdays, I o:00am-6:00pm Saturdays,
excluding Sundays and Pederel Holidays.
4, oto removal or fill of fuel tanks found on site, obtain i
separate tank permit from City.
5. Grade the lot back to the original grade contours.
6. Contact the Bngiueering Division for required repairs and
permits if damage is done to public property (i.e.
sidewalks, streets, utilities).
7. Dump all materials at approved dump sites.
8. Maintain erosion control measures. I
�T
INRWr VC8411WuuW1 ••v............r..
1, Call Eneineedu Inmector for Heal Dlmolltion Inspection
f425) 171:922Q ext 1326:
The Engineering Imspector will verify than
1. City streets are cleaned of debris.
2. Erosion control measures are maintained.
3. No damage occurred to public property.
4. City Utilities remain capped.
2. Call Buil iny Inspector for Final DemoUtlon Inspection (425)
771-0220 eKt 1333 s
• The Building Inspector will verify that:
1. All debris is removed from the site.
2. Final grading is complete.
3. Determine if temporary construction fencing is required
for safety purposes. -
3. Call Permit Coordinator tit the City of Edmond; [Or relMe_0
Dem litfon Bond (425) 771-0220.
°F E1)Moy Inspection Comments
BLD20110541 23 - Demolition
Applied: 07/14/2011 Issued: 08/09/2011
Expires:
02/09/2012
Address: 17500 72ND AVE W, EDMONDS
!INSPECTION DATE
INSPECTOR
ACTION
1078. E -Pre -Demolition Sewer Cap 10/13/2011
LAMBERTJ
PAR
Comment: OK to demo w/out capping sewer - contractor is not removing foundation
1078 - E -Pre -Demolition Sewer Cap 10/19/2011
ZULAUF
CMP
Comment: per JL -not required
1079 - E -Pre -Demo Water Sery Discnct/AVB 10/13/2011
LAMBERTJ
PAR
Comment: OK to demo - water not disconnected since contractor is not removing foundation
1079 - E -Pre -Demo Water Sery Discnct/AVB 10/19/2011
ZULAUF
CMP
Comment: Per JL -not required
1080 - E -Pre -Demo Erosion Control 10/13/2011
LAMBERTJ
CMP
Comment: OK to demo - TESC adequate at this time
1081 - E -Engineering Final Demo 10/19/2011
ZULAUF
CMP
Comment:
1104 - B -Final Demolition 10/24/2011
BJORBACK
CMP
Comment: Inspected by RS & LB on 10/21/11. Existing foundation still in place.
12/20/2011 9:20:13 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:
❑ Vaful& 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).
6 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
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. 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).
0 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 day of , 20 0 .
PROPERTY OWNER/AUTHORIZED WITNESS
PERSON
Signature Signature V
Print Name Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07