BLD20130682.PDFAl-kof ED41
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
Inc. 1890
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 07/03/2013 T Permit #:-BLD20130682!
Ex
�� � EDM DRExpiration Date: 07/03/2014 Pro"ect;Ad OLYMPIC V1E ,
OND
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Address": 7
Parcel No: 00596700000100
P.O
WILSON TSUI WILSON KAM KUEN & RITA PU TSUI HOMEOWNER EXEMPTION TAKEN
17604 OLYMPIC VIEW DR 17604 OLYMPIC VIEW DR
EDMONDS, WA 98026 EDMONDS, WA 98026
(425)745-2828 (425)745-2828
LICENSE #: EXP:
JOB DESCRIPTION
ADDING A SINK AND SHOWER TO THE LOWER LEVEL/BASEMENT. ""PLETED
VALUATION: $800.00
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PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alteration/Remodel
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:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
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
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK SIDE SETBACK REAR SETBACK
REQUIRED: PROPOSED: RE UIRED: PROPOSED: RE TUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O ]REQUIRED: PROPOSED:
SETBACK NOTES:
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.
THIS.APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
UT1=
toe Print Name Date
ATTENTION
IT 1S 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/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR I� OTHER ►/--� �.J/
STATUS: ISSUED
20130682
• 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.
INSPECTIONS
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 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 requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
• B-Plumb Ground Work
• B-Plumb Rough In
• B-Mechanical Rough In
• B-Framing
• B-Building Final
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).
❑ 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).
91 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).
❑ 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 I 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 j
PROPERTY OWNER/AUTHORIZED
PERSON
Signature
•. -
Print Name IV
WITNESS
Signature
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07'
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City of Edmonds
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5 h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 2 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
-PROJECT ADDRESS (Street, Suite #, City State, Zip):
176OLf OLUIPIc Vi W
Parcel #:
Subdivision/Lot #:
Project Valuation: $�}
APPLICANT:
0 'i,SDW TLSLk
I
Phone:
#) 5- 745s 2-y2
Fax:
Address (Street, City, State, Zip):
751-2 ) Y MOC. 'i E\),,A
E-Mail Address:
TSs il 1133,3 (p, 40, (D
PROPERTY OWNER:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address: ,
CONTRACTOR:*
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
*Contractor 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
WA State License #/Exp. Date:
City Business License #/Exp. Date:
DETAIL SCOPE OF WORK: App
L�u�>� � 6Rs�1►��NT
1 NC4 A 5 i N k AND S HQW E R TO T B C 1-0" E R
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement:
sq. ft.
Select Basement Type: ❑ Finished ❑ Unfinished
lst Floor:
sq. ft.
Garage/Carport: sq .ft.
2'd Floor:
sq. ft.
Deck/Patio: sq. ft.
Retaining Wall: ❑ Yes ❑ No
Other: sq.ft
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: W LS O LQ\ TS Lk W Owner ❑ Agent/Other (specify):
Signature: 1 ' G Date: ��' - 9-6( 3
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New driveTorm A.doe
Updated: 10/2011
4 OF EpA
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City of Edmonds
Equipment Type
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
121 5t' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 It Fax 425.771.0221
Appliance/Equipment Information (new and relocated) Total #
Furnace
# Gas # Elec # Other: BTUs: <100k >100k Location
Air Handler/ACNAV
#_Gas #_Elec #_Other: CFM: <100k_>100k_ Location
Boiler/Compressor/
Heat Pump/Roof Top
Unit
#_Gas #_Elec #_Other: BTUs: <100k, 100k-500k, 500k-1Mil
HP: <3, 3-15, 15-30 Location
Hydronic Heating
#_Gas #_Elec _In -Floor, _Wall Radiant, Boiler BTUs: Location
Exhaust Fans (single
duct)
Location: #_Bath #_Kitchen # Laundry # _Other:
Fireplace
#_Gas #_Elec #_Other: Location
Other
FUEL GAS
Number of Outlets Fixture/Appliance Type
AC Unit --------------- BTUs: Location:
Furnace --------------- BTUs: Location:
Water Heater -------- BTUs: Location:
Boiler ------------------ BTUs: Location:,
Fireplace/Insert BTUs: Location:
Stove/Range/Oven:
Dryer
Outdoor BBQ:
Other:
TOTAL OUTLETS
him
PLUMBING FIXTURE COUNT
Number Fixture Type Number Fixture Type
Water Closet (Toilet)
Refrigerator water supply (for water/ice dispenser)
I
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
Tub/Shower
Drinking Fountain
Dishwasher
Bidet/Urinal
Hose Bib
Pressure Reduction Valve/Pressure Regulator
Water Heater _ Tankless? Yes_ No_
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Expansion Tank for Water Heater
Hydronic Heat in: Floor Wall
Drain/Floor Sink
Other:
LjFloor
Clothes Washer
Other:
FORM A L:\Building New Folder 2010\130NE & x-ferred to L-Building-New drive\Form A.doc Updated: 10/2011
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RECEIVED
opy'JUN 2.5 2013
CISICES CTR.
DEVELOPMENT SERV
CITY OF EDMONDS
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CITY OF EDMONDS�
BUILDING DEPARTMENT
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DG. OFFICIAL
PERMIT NUMBER
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Smoke alarms shall be installed in each sleeping room,
- - - — c�utsideof-ea separate sleeping area in,
the immediate
vicinity of the t edrooms, and on each level (including
basements and abitable attics) in new construction and in
existing dwelli LM s when alterations, repairs or additions
requiring a perip occur. Smoke alarms shall be hard-
wired with ba tery backup, and when more than one
smoke alarm i (required within an individual dwelling
unit, they shall e interconnected. Discuss exceptions to
the power s `� ce, 'requirements with the Building
Inspector.
IR 14 IBC 907.2.11.2
D I �«.wA'lr�
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Room
�\ 22 ECEIVEM
JUN 2 5 2013
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
Carbon monoxide alarms shall be
n talled outside of each separate
SIT ing area in the immediate.
vicinity of the bedrooms and on each
level in new construction and in
_.�.�.
exI�ting dwellings when alterations,
-repairs or additions requiring a permit
cAur, or when one or more sleeping
j rooms are added or created.
i IRC R315
I
Vent all plumbing fixturef1through
the roof per UPC 906.0 of" th-a
loop vent per UPC 909.Or. r
admittance valves are not p�enitted
unless first approved tby.the
Building Official under anY lterrnate
method per UPC 301.2.
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