BLD20150355.PDFCITY OF EDMONDS
STATUS: ISSUED 03/30/2015
Expiration Date: 09/30/201.5
Parcel No: 00434600007800
CHRISTOPHER A & MERIN L MIONE
19011 OLYMPIC VIEW DR
EDMONDS, WA 98020-2354
(206)605-4870
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Permit;# ,BLD2015035`5
Project Address: 1,9011- OLYMPIC .VIEW DR,
EDMONDS`
CHRISTOPHER A & MERIN L MIONE OWNER EXEMPTION
19011 OLYMPIC VIEW DR
EDMONDS, WA 98020-2354
(206)605-4870
LICENSE #: EXP:
DESCRIPTIONJOB
DEMO EXISTING POOL BY BREAKING OUT BOTTOM OF FIBERGLASS POOL AND FILLING IN WITH THE EXISTING
SURROUNDING CONCRETE. GRA SS TO COVER.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 23 - Demolition
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: ( 0 X 0 FT.)
CODE: 2012
OTHER: ------- OTHER DESC:
ONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1ST 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: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINGCONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGT0
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.
%�� C4, , Glut,, � -70 -,/ � LlMa 7hol-hLtfisk Mal-ch 30, 2al,S
Siena ure Print Name Date Released By 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 10/ IRCI 10.
a ONLINE APPLICANT ASSESSOR �OTHER ��
STATUS: ISSUED
BLD20150355
• 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 ffomthe 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)
PUBLIC WORKS 425) 771-0235 1 PR&TREATMFNT 425 672-5755 1 RECYCLING 425 2754801
When calling for an inspection please lease 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.
• E-Pre-Demo Erosion Control
• E-Engineering Final Demo
• B-Preconstruction meeting
• B-Building Final
DEVELOPMENT SERVICES
_ RESIDENTIAL BUILDING PERMIT
APPLICATION
�Sr 18go 121 5"' Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTLML BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PR CT ADDRESS (Street, Suite #, City State ip):
� o & tc /ew e
Parcel #:
3 ��-
Subdivision/Lot #:
Project Valuation: $
APPLICANT: '1
I any
Phone:
(-60� u�7o
Fax:
Address (Street, City, State, Zip):
5� �'
E-Mat Address:
, Gi �F G seta , G
PROPERTY OWNER- �
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State,kip):
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 THE SCOPE OF WORK: 1 / i!✓ EA'S,7i�-, �Grs��ib�ic%,a SS O®d
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement: s . ft.
Select Basement Type: Finished LJ Unfinished LJ
V Floor: s . ft.
Garage/Carport: s . ft.
2 nd Floor: s . ft.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: s . ft.
Fire Sprinklers: Yes
Ll
No
Retaining Wall: Yes No
I declare under penalty of perjury laws that the information I haveprovided on this fornVapplication is true, correct and
complete, and that I am theproperty owner or duly authorized agent of the property owner to submit apermit application to
the City of Edmonds.
Print Name: C S O ""Ve Owner Agent/Other ❑ (specify):
Signature/f Date:
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Fonn A2014.docx Updated: 1/17/2014
F
O
Al
DEVELOPMENT SERVICES
_
RESIDENTIAL BUILDING PERNUT
APPLICATION FORM A
Fit 1 gqo
121 5 h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 4 Fax 425.771.0221
Equipment Type
MECHANICAL
Appliance/Equipment Information (new and relocated) Total #
Furnace
Gas #—Elec
# Other:
#_ BTUs: <100k >100k Location(s)
Air Handler / VAV
Gas #
Elec #—Other:
# CFM: <10k >10k Location(s)
(circle selected)
—
—
AC / Compressor /
Boiler / Heat Pump /
Gas #—Elec
#—Other:
#_ BTUs: <100k, 100k-500k, 500k-1Mil
Roof Top Unit
HP:
<3, 3-15,
15-30 Location(s)
(circle selected)
Hydronic Heating
Gas #—Elec
#—In-Floor
Wall Radiant— Boiler BTUs: Location
Exhaust Fans (single
Bath #
Kitchen #_Laundry # #_
duct)
_Other:
Fireplace
Gas #
Elec # Other:
#_ Location(s)
Dryer Duct
FUEL GAS
Appliance Type.
Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:
Location(s):
Furnace
BTUs:
Location(s):
Water Heater
BTUs:
Location(s):
Boiler
BTUs:
Location(s):
Other:
BTUs:
Location(s):
Fireplace/Insert
BTUs:
Location(s):
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
PLUMBING
Fixture Type (new and relocated)
Total # Fixture Type (new and relocated) Total #
Water Closet (Toilet)
Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
Tub/Shower
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes ❑ No ❑
Hydronic Heat in: Floor Wall ED
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A L:\Building New Folder 201000NE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014
-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
1 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. 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 day of , 201
PROPERTY OWNER/AUTHORIZED
PERSON
e55Si a
Print Name
WITNESS.
Signaft` e ,
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
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City of Edmonds Building Division
APPROVED PLAN
Pool Demolition Requirements
• De -chlorinated water shall be dumped directly into a sanitary sewer cleanout. Pool water is NOT permitted to
be dumped into yards or storm drains unless specifically approved in advance by the Public Works Director.
• Pool slab and walls shall be reduced down to pieces less than 12" in diameter.
• All rebar shall be removed from the concrete and the site.
• Piping shall be removed completely (cannot be abandoned in place).
• Mechanical equipment shall be removed from the site.
• Vinyl, fiberglass, and other linings cannot be used for fill and shall be removed from the site.
• Wood cannot be used for fill.
• All fill shall be clean fill and free draining, and areas supporting a structure be compacted to 90% proctor
(verified by Special Inspection).
• Use of any other unusual materials for fill must be approved by the Building Official.
Nothing in this permit approval
process shall be interpreted as
allowing or permitting the
maintenance of any currently existing
illegal, nonconforming, - or
unpermitted building, structure,' or
site condition, which s ouiside the
scope of the permit apI'�licaion, ;
regardless of whether 'such bui4ng,
structure, or condition is shoe n on,the',
site plan or drawing. Such building,
structure, or condition mayl , be. the
subject of a separate enforcement
action.
ALL WORK SUBJECT
TO FIELD
INSPECTION FOR
CODE COMPLIANCE
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