BLD20190704E LD)
STATUS:
Expiration Date: 1
Parcel No: 27042900302300
CITY OF EDMONDS
121 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Pennit#: BLD20190704
9 L --Kroject Address: 221 It HIGHWAY 99, EDMONDS
P AO P _rvl TY 0 1zz&WX APPLICANT CONTRACTOR
HARBOR FREIGHT TOOLS CONT RA CT OR'S ROOF SERVI CE INC CONTRACTOWS ROOF SERVICE INC
C/O EDMONDS VENTURES LLC BEHAR C/O JEFFREY RANKIN C/O JEFFREY RANKIN
1000 2ND AVE STE 3230 6406 43RD AVE CT NW 6406 43RD AVE CT NW
SEATTLE, WA 98104 GIGHARBOR,WA 98335 GIGHARBOR,WA 98335
(253) 8 58-3 044 (253) 858-3044
LICENSE #: CONTRRS035138 EXP:01 /29/2021
JOB DESCRIPTION
ROOF OVERLAY 18,000 SQFT. TPO STNGLE PLY MEMBRANE.
VALUATION: $36,000
PERMIT TYPE- Commercial
PERMIT GROUP: 54 - Re-Roof/RoofAlter/Repair
GRADING: N CYDS- 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD
FENCE: 0 X 0 FT-)
CODE
OTHER: ------- OTHER DESC:
IZONE:
INUMBER OF STORIES: 0
1 VEST ED DAT E -
[NUMBER OF DWELLING UNIT& 0
ILOT #:
ENISTING AREA
I ST FLOOR: 0 2ND FLOOR: 0
PROPOSED ARIA
�EMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR 0 GARAGE: 0 DECK - 0 OTHER 0
BEDROOMS: 0 BATHROOMS: 0
IBEDROOMS: 0 BATHROOMS: 0
FRONTSFTBACK SIDESETBACK REAR S FIFR ACK
REQUIRED: PROPOSED: 17EQUIRED: PROPOSED: IREQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED�
SETBACKNOTES:
I AGREE TO COMPLY W1THC1TY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
PERSON WILL BE EMPLOY ED 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.
Signature Print Na
Denise Nelson 6/14/19
ed By
Date
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC]09/113CI I0/IRCl 10.
= FIRE = APPLICANT = ASSESSOR = crry
z
41000
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STATUS: ISSUED BLD20190704
CONDITIONS
• 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 final project approval and final
occupancyinspections.
• Any request for altem ate design, modification, variance or otheradministrative 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 accordancewith the appropriate provision
of city code or state law does not approve any items not to code specification.
• Sound/Noise originating from ternporary construction s ites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00arn 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
han-nless 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 th is pen -nit. 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)
BUILDING
ENGINEERING (425) 771-0220 EXT. 1326
1. Go to: www.edmondswa.gov
Building Department Inspections
2. Then: Services
are now scheduled online. If you
FIRE (425) 775-7720
3. Then: Perm its/Devel opment
have difficulties, please call the
4. Then: Online Permit Info
Building Department front desk for
PUBLIC WORKS (425) 771-0235
5: If you don't have one already, create a
assistance during office hours.
login (upper right hand corner)
(425) 771-0220
RECYCLING (425) 275-4801
6: Schedule your inspection
I
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.
a B-Building Final
._*11%
fir
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.gov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, Large Additions, ADU's, New Commercial, and Major Tenant
Improvement application submittals. If plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please call 425-771-0220 to schedule an intake appointmentl
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 11111 4
Parcel: 11oi+,2q0vhQ
Lot /Unit/Suite 9: Subdivision:
PROPERTY OWNER:
Name: PRAV, MORN VL0WP_1;'Q
Mailing Address: Vo Nv� �W4
City/State/Zip: �m I WA qgwa
Phone#: U(9- IGIGICJ
Email: MhHP 0EARCOMPM4�1'. CAA
OWNER INSTALLATION- *If yes, read and sign*
Will work be performed by the property owner? 0 Yes 0 No
I own, reside in, or will reside in the completed structure. 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:
I
APPLICANT / CONTACT INFORMATION:
Name of Applicant: CoaNCA(S Row �ow kc'�_' w.
Mailing Address: UJA WD \\IE U NW
City/State/Zip: �k(j %;�� "
IA— � '%15% , Ao%
Phonett: L%O) .."O"D
E-mail: PIDWA @y cp��10`QvMd-ebv
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI M d Oil 00 N LP
CITY OF EDMONDS BUSINESS LICENSE #- 0- 00t -%07-1 OSI
VYA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
_UNTRFI-1� 0�09 0 t 12112A
Office Use Only
mffv%,�� =
TYPE OF PERMIT (Provide Details on Page 2)
• Accessory Structure/ 0 Addition
Detached Garage
• Demolition
0 Mechanical
• New Single Family/ Duplex
0 Plumbing
• Fire Sprinkler
0 Remodel
• New Commercial/ Mixed Use
Re -Roof
• Signs
0 Tank
• Tenant Improvement
0 Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished 0 Unfinished 0
Ist Floor, sci ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
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VUM�q � NUN LL (4) LK
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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.
�4ES
Print Name:Wflo,
Signature: q, Pon-,— Date Owl' I / 19
N
4_0
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes El No El
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, 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
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas Elec Other Cty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUMBING FIXTURE COUNTS (New, Relocated or re -piped)
Clty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re -piped)
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey donQY N
PSCAA Case #:
Critical Areas Determination:
Study Required 11 Conditional Waiver 11 Waiver
Fill in Place Fill Material:
Removal El
Size of Tank (Gallons)
Critical Areas Determination:
Study Required ED Conditional Waiver El Waiver 0
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No 0
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of I year.
ESLHA Applications, 2 years,
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.
STA
6, V.
STATE OF WASHINGTON
BUSINESS LICENSING SERVICE
Thank you for filing online
Our processing time generally takes up to 10 business days. Some endorsements may take more time for state or city
approval. You will receive your business license with approved endorsements in the mail. An updated business license
will be mailed to you when additional endorsements are approved.
Confirmation Number: 0-008-807-905
Payment Method: ACH Debit/E-Check
Business Entity Information
Filing Date and Time: 06/11/2019 09:42:57 AM
Entity Type: Corporation
Name of Entity:
AccountID: 601760396-001-0001
Firm Name: CONTRACTOR'S ROOF SERVICE, INC.
Endorsement(s) Applied For
Edmonds General Business - Non -Resident
Fee Type
BILS Processing Fee
Commence Cease Count Fee
06/11/2019 06/30/2020 1 $50.00
$50.00
Commence Cease Count Fee
06/11/2019 1 $19.00
$19.00
Grand Total: $69.00
tXL0004