BLD20170063.pdfAT
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN
OCCUPANCY HAS BEET,
ONLINE APPLICANT
vale
AND APPROVAL ORA CERTIFICATE OF
IZI OTHER vI/
STATUS: ISSUED BLD20170063;
• 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.
r 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 fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 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.
PERMITTIME+LIMIT: SEE ECDC 1900.005(A)(6);'
C,ALL FOR INS PFI -TIONS
BU"1NG 425 771-0220 EXT. 1333 FNGIl IMMIG 425 771-0220 EXT. 132621RE (125)'775-7720
PUBLIC WORKS (425) 771-0235 PR&TREATMENT 425) 672-5755 RECYCLING (425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being
r ( ested, Contact Name and Phone Number Date Preteree and whether od prefeftnorning or afternoon.
• B-Preconstruction,meeting
• B -Window Flashing
• B-Insulation/Energy
• B-SheetrockNail
• B -Plumbing Final
• B -Roof Tear Off
• B -Mechanical Final
• 13 -Building Final
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
uSt i 9 121 5"' Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 ft Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJE : T" ADDRESS (Street y'uite #, City State, ZI ),)- Parcel #:
Subdivision/Lot #:
APPLICANT:
C f t 2-
Address (Sl
reet C"it:y, State Zip).
PP
PROPERTY OWN ER
AddressStreet, City, State, Zip):
1. iWl" DING AGENCY:
Address (Street, City, State, Zip):
CONTRACTOR:*
/tticT°6ss (Street, City, State, Zip):G
f,J� Project Valuation: $
Phone: ,.�, t. m. Fax:
E -Mail Address:
4
Ph,oIle, Fax:
E -Mail Address:
Phone: Fax:
E -Mail Address:
Phone: I, Fax:
C9 ti 1 E -Mail Address:
WA State License #/Exp. Date:
*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 1 City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK I t
A'
PROPOSED NEW S UARE
Basement:.. __.� .. .. st , ft.
1" Floor:..
F Floor: WIN
Bedrooms #_ Full -3/4 Bath #w ,._ Half -Bath
Fire S orinklers: Yes No 71
GradinL: Cut cu. vds. Fill__ ,,,_cu,yd5
r
TAGE FOR THIS P ROJEC'`I°
Select Basement'r e Finished Unfinished .
Gar age/C" ar )art: - ....._.. st ft.
Deck/Cvrd Porch/Patiomm.�.._... rt . ft.
Other _.._"ta.ft.
Retaining Wall: Yes LNo
Cut/Fill in Critical Area: Yes !, 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: Owner 54 Agent/Other EJ (specify):
Signature: �..�' �' .....�._.� Date:
FORM A LABuildiug New Folder 201MDONE: & x-ferred to L -Building -New driveTorrn A2014.docx Updated: 1/17/2014
0 s
Al r
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 9 Fax 425.771.0221
Equipment Type Appliance/Equipment Information (new and relocated) Total
Furnace Gas 4lV:lec —Other:
w �
On.� .
#-W,,_, tl"I'll ": <I(Illk.._,a li)tldc Location s W, ,
Air Handler / VAV Gas 4__Eje #. OIher:'..�...W
#`.�.n.- CleM» <'IOk �„ > IOk„....__ I oezltidtn(t)
(circle selected)
..-� �.p
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,mm, –.,, — ..----
Exhaust Fans (single Bath #_Kitchen # .Laundry # wt)tlter:, � _.._w � _ w__________
duct)
Fireplace Gas#� lec#`Other:
#®
Dryer Duct
Appliance Type Appliance/Equipment Information (new and relocated) Total #
AC Unit BTUs:
Location(s)•.,e _._.... _.__.ww.
Furnace BTUs:-�._._...._-._
Location(s).—._..--.-......._.—......
Water Heater BTUs:
--
.............. Locatton(s):,.._..�.�, _ 6,.�.�.------- —._ ._
Boiler BTUs: ._.m._.. � .....,...
._ Location(s):—,,,,----,,,,,,.........W_
_..�
......-- .._... .. �....�......
Other _.. BTUs:Location(s)u_--._
. - _
Fireplace/Insert BTUs:..._....
.......__.�. .
Location(s): �._ ...._ .. ,,,,
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
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 0
Floor Drain/Floor Sink
-
Other:
-.
Refrigerator water supply (for water/ice dispenser)
g pp y er/ice dispenser)
Other:
FORM A L:\Building New Folder 2010\DONE & x -ferrel to L -Building -New drive\Form A2014.docx Updated: 1/17/2014