BLD2019-0226111111111 0�x -.P .
08 14 � D
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE. (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 03/25/2019 Pemiit#: BLD20190226
I BUILDING PERMIT
Expiration Date: 09/25/2019 Project Address: 1250 BIRCH ST, EDMONDS
Parcel No: 00515200001000
JORDAN & SAMANTHA S R HOPPER ROMAN POOL AND SPA ROMAN POOL AND SPA
1250 BIRCH ST CIO TONY ROMAN C/O TONY ROMAN
EDMONDS, WA 98020-6616 4515 134TH ST SE 4 108 4515 134TH ST SE # 108
MILL CREEK, WA 98012 MILL CREEK, WA 98012
(425) 678-3618 (206) 4 12-6545 (206) 4 12-6545
LICENSE k ROMANPS823PU EXP: 10/31/2020
JOB DESCRIP-HON
DrMOPOOL,R OVE POOL DECK, REMOVING SHED
VALUATION: $0
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
IOTHER ------- OTHER DESC
ZONE
INUMBER OF STORIE& 0
IVESTED DATE:
INUMBER OF DWELLING UNITS 0
ILOT #�
EXISTING ARF�%
IBASEMENI 0 1 ST FLOOR: 0 2ND FLOOR: 0
PROPOS[I)ARLik
[BASEMENT 0 1 ST FLOOR: 0 2ND FLOOR 0
13RD FLOOR 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR 0 GARAGE 0 DECK: 0 OTHERi 0
1BEDROOMS: 0 BATHROOMS: 0
1 BEDROOMS: 0 BATHROOMS: 0
PERMIT APPROVAL
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, N—O
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.
— '�� 1, -f, )�" '7e A , Z,v er-- 3 -,?- S-- 19 / I '�)l z d.. rt �- Q! �� � 0312-512-01?
Print
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- UBCI 09/ IBCI 10/ IRCI 10.
RRE APPLICANT ASSESSOR F�K] crry
STATUS: ISSUED BLD20190226
CONDITIONS
• 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 thejob 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-reftindable.
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 7:00amto 6:00pm on weekdays and 10:00arn 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
harinless 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)
TO SCHEDULE INSPECTIONS
I BUILDING . I I ENGI NEERI NG (425) 771-0220 EXT. 13?L_�
1. Go to: www.edmondswa.gov
2. Then: Services
3. Then: Perm its/Development
4. Then: Online Permit Info
5: If you don't have one already, create a
login (upper right hand corner)
6: Schedule your inspection
Building Department Inspections
are now scheduled online. If you
have difficulties, please call the
Building Department front desk for
assistance during office hours.
(425) 771-0220
FIRE (425) 775-7720
PUBLIC WORKS (425) 771-0235
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 Preferred, and whether you prefer morning or afternoon.
• E-VERIFY POOL BOTTOM BROKEN OR DRIL
• E-Pre-Derno Erosion Control
• E-Engineering Final Demo
• B-Final Demolition
""C' 191),
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 Sth Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, Permit status and inspection
scheduling information 90 to: bUQ;//www.edmondswa.jZoyj
JOB SITE 'NFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: dff I
21", —
LooParcel: IC2 - (D
t Unit/Suite #: Subdivision: 6011" ek
PROPERTY OWNER:
Name: IV
MailingAddress: lajo
City/State/Zip: yj c'l
Phone #:
Email:
OWNER
INSTALLATION: yes, read and sign*
Will work be Performed by the property owner? 0 Yes - '/
ucture.
own, reside in, or will reside in the Completed str V-0
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPLICANT/ CONTACT INFORMATION:
Name of Applicant:
Mailing:Address:
- Ili 5
City/State/Zip:
Phone #: '2
06
E-mail: ��(72 00e
00t
SENERAL CONTRACTOR: (if different from applicant)
General Contractor:
Mailing Address:
City/State/Zip: f.? 1Pjt7__L'&1 6*4 4
Phone #:
E-mail: kv A
y 09 00—
.1 — —
WA STATE CONTRACTOR L Sk I # (CCB) 81 EXPIRATION DATE:
CITY OF EDMONDS BUSINESS LICENSE #:
Permit #:
# 7 1
El Accessory Structure/
Detached Garage 0 Addition
E] M c ical
'�Lemolition tv 0 Mechanical
El New
. Single �Famiily/�Duplex El Plunmbing
0 Fire Sprinkler r
E01 �Remoclel
El New Commercial/ Mixed 7Use 101 Re -Roof
0 Signs C] T
0 Tank
0 Tenant Improvement 0 Other
Remodel Permit fees are based on:
The value of f he work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, matedals, labor, overheacl,
and the Profit for the work indicoted on this application,
Valuation: qk
l3asement sq ft:
Ist Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio,
Other sq ft:
Finished 0 Unfinished El
A_w
1W J�v
I 61E:�il'06
W_Wee hew q ly
q�"e &e S'jf
I certify 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:
Signature Date
In
Occupancy Group(s):
Occupant Load(s):
Spri
Type(s) of Construction: Fire Sprinklers: Yes 11 No El
WA STATE ENERGY CODE: If Your project affects the building envelope,
mechanical systems, and/or fighting, You must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated Plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
-----------
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
BTUs Gas / Elec / Other
QtY
A/C Unit /Compressor
I AirHandler/VAv
I Boiler
Dryer Duct
FExhaust Fans
Fireplace
---------------
Furnace
----------------
Heat Pump Unit
EHydronic EHeating
Roof Top Unit (Provide eleva-
tions if a commercial Bldg)
Other:
Qty
Clothes WHasher
EDishwasher
Tub/ Showers
c low
EBa kflEowDevice (RP13A, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
:Ioor Drain/Sink
Refrigerator Water Supply
lose Bibs
Water Heater - Tankless? Y or N
lydronic Heat
Water Service Line
;inks
Other:
roilets
Other:
Qty
BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Boiler: C/ ir it
Stove/Range/Oven
Dryer
r t r
Water Heater
Fireplace/ Insert I I I Other:
Furnace I I I Other:
Carbon Dioxide
Nitrous Oxide
Carbon Dio d
EHelium E Nitrous Oxide
Oxygen
Medical Air 0
Other:
Medical -Surgical Vacuum Ot r.
Other:
Type of structure to be demolished:
C�rlr'I 4)") L_
Square footage of structure to be demolished: 33
AHERA Survey done? Y/N TFSCAA
Critical Areas Determination;
Study Required El Conditonal Waiver 0 Waiver 0
Fill in Place Fill Material:
Removal ED TSize of Tank (Gallons)
Lntical Areas Determination:
Study Required 0 Conditional Waiver EJ Waiver
Grading: Cut cubic yards
T1 a "qt///—cubic yards /'Oo
Cut/ Fill in Critical Area: Yes �q No C1 501)
BTUs Qty
APPLICATIONS: Applications are valid for a maximum of I year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subrontractors are required to be licensed
with Washington State Department of Labor & Industriesand have a
current City of Edmonds Business License.
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CITY OF EDMONDS
BUILDING DEP RTMENT
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ADDRESS
OWNER
APPROVED DATE:
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