BLD20160831 (2)4F
OF E MDR
CITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
c
o PHONE: (425) 771-0220 - FAX: (425) 771-0221
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IN
STATUS: ISSUED 01/23/2017 Permit #: BLD20160831
BUILDING PERMIT
Expiration Date: 01/23/2018 Project Address: 24027 101ST AVE W, EDMONDS
Parcel No: 00555000002500
hKiPPIATV11NITNER APPLICANT CONTRACTOR
MICHAEL T HASSE MICHAEL T HASSE OWNER EXEMPTION
24027 101 ST AVE W 24027 101 ST AVE W
EDMONDS, WA 98020 EDMONDS, WA 98020
(206)579-1722 (206)579-1722
LICENSE #: EXP:
1: 1 _ :I' 1►
CONVERT GARAGE TO LIVING SPACE
2 BEDROOMS, STORAGE ROOM AND OFFICE
VALUATION: $4,100.00 HNAL
PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alte — _
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION: VB
RETAINING WALL ROCKERY:
OCCUPANT GROUP: R-3
OCCUPANT LOAD:
FENCE: ( 0 X 0 FT.)
CODE: 2012
OTHER: ------- OTHER DESC:
ZONE: RS-8
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: I
LOT #:
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PROPOSED
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
BEDROOMS:0 BATHROOMS:O
BEDROOMS:0 BATHROOMS:0
FRONT1
REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED-0 REQUIRED: PROPOSED:
SETBACK NOTES: Garage conversion remodel. No expansion of existing footprint.
I AGREE TO COMPLY WITH CITY AND STATE LAWS. REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THI APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
7 - X 1Z CAzi&� Lt)� 112_3Z�017
Signature Print Name Date Released By Date
ATTENTION
ITIS 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/ IBC110/ IRC110. ^
ONLINE APPLICANT ASSESSOR P(O;HM �,��
N
STATUS: ISSUED
BLD20160831
• Final approval on a projector 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 fin a] project approval and final
occupancy inspections.
• Any request for altemate 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 fromtemporary 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)
ENGINEERING (425) 771-0220 EXT. 1326
PUBLIC WORKS 425 771-0235 PRIITREATMINT 425 672-5755 RECYCLING 425 2754801
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-Preconstruction meeting
• B-First Floor Framing
• B-Plumb Rough In
• B-Mechanical Rough In
• B-Framing
• B-Building Final
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
�St. 189ro 121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 Q Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
24027 101 st Ave W, Edmonds, WA 98020
Parcel #:
00555000002500
Subdivision/Lot #:
Project Valuation: $
$4072
APPLICANT:
Michael T Hasse
Phone:
206-579-1722
Fax:
Address (Street, City, State, Zip):
24027 101 st Ave W, Edmonds, WA 98020
E-Mail Address:
PROPERTY OWNER:
Michael T Hasse
Phone:
206-579-1722
Fax:
Address (Street, City, State, Zip):
24027 101 st Ave W, Edmonds, WA 98020
E- ail Address: IT-
M AAS L
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Homeowner
Phone:
206-579-1722
Fax:
Address (Street, City, State, Zip):
24027 101 st Ave W, Edmonds, WA 98020
E-Mail Address:
/t
*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: Convert garage into two bedrooms, storage room and office
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement: s . ft.
Select Basement Type: Finished LJ Unfinished
Is'Floor: s . ft.
Garage/Carport: s . ft.
2"d Floor: s . ft.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: s . ft.
Fire Sprinklers: Yes
No
Retaining Wall: Yes
No
Grading: Cut cu. yds. Fill cu.yds.
I Cut/Fill in Critical Area: Yes LJ No
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: Micha T Hasse Owner ❑✓ Agent/Other ❑ (specify):
Signature: 1 e-,7 Date: 21-June-2016
FORM A L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORMI)
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
18.27.09q(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).
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. 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 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 -iZ day of "y , 2016_.
PROPERTY OWNER/AUTHORIZED
PERSO
Signature
Az_ r 1 -s
Print Name
Inn :1
C
Si a e
L lv�d. F'v,
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07
101 st Ave W - Google Maps
Page I of I
Edmonds, Washington
Street View - Aug 2011
101st Ave W
htt.l)s://www
le,com/tnaps/@q)47,7905512,-122
3tn6!lcl!3m4!lsfeJlw,., 6/22/2016