BLD20190831CITY OF EDMONDS
1215THAVENUENORTH -EDMOT\1DS,WA 98020
1w PHONE: (425) 771-0220 - FAX: (425) 771-0221
". 1'691�
STATUS: ISSUED 07/08/2019
Expiration Date: 01/08/2020
Parcel No: 01016400010000
Permim BLD20190831
roject Address: 128 4TH AVE S, EDMONDS
PAIIIPERTV O"N'TUR APPLICAN'll' CONTRACTOR
COPPERSTONE CONDO ASSOC LOBERG ROOFING COM. INC. LOBERG ROOFING COM. INC.
C/O JANET ZEPEL C/O JOSH KRAUSE C/O JOSH KRAUSE
128 4TH AVE S PO BOX 5386 PO BOX 5386
UNIT 204 LYNNWOOD, WA 98036 LYNNWOOD, WA 98036
EDMONDS, WA 98020
(425) 775-2276 (425) 775-2276
LICENSE It: LOBERR*972K8 EXP:06/05/2021
JOB DESCRIPTION'
RECOVER EMSUNG ROOF WITHNEW TPO ROOFINGMEMBRANE
VALUATION: $7,600
PERMIT TYPE: Commercial
PERMIT GROUP: 54 - Re-Roof/RoofAlteriRepajr
GRADING. N CYDS: 0
TYPE OF CONSTRUCTION -
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE:
IOTHER ------- OTHER DESC
JZONE�
INUMBER OF STORIES: 0
IVESTEDDATE:
INUMBER OF DWELLING UNITS: 0
ILOT #�
EMSTING ARF�%
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PRO POSED AREA
�EASEMIENT� 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
1 BEDROOMS: 0 13ATHROOMS: 0
FRONTSETBACK SIDESE-FBACK REARSETBACK
REQUIRED: PROPOSED: JrQUIRED: PROPOSED: IREQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
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.
7
Xt11gjee)Z_ 7/8/19
Signature Print Name Date Released By Date
ATTENTION
IT IS UNLAWFUL TO USE OROCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/IBCI 10/IRCI 10.
= FIRE = APPLICANT = ASSESSOR I Crry
N MIN
LWJ
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STATUS: ISSUED BLD20190831
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-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 e)cmpt from the 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 indermify 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, aris ing directly or indirectly from the issuance for this 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 PERMITAUTHOREES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRKIATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDB/VALKS, DRKIB/VAYS, 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: SeNces
are now scheduled online. If you
FIRE (425) 775-7720
3. Then: Perm its/Development
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 ha\e 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.
• B-Roof Tear OfF
• B-Building Final
'Oe. lS9%3
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 appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 1c,7 0G, �4 due. S'
Parcel:
Lot /U n it/Su ite #: Subdivision:
PROPERTY OWNER:
Name:
Mailing Address:
City/State/Zip:
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? 0 Yes El 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:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: '4 464"_'r e_
_:J�s —
Mailing Address:
City/State/Zip:
Phone #: � '?, E — S 0 Pt — c:;� 0 ';Z
E-mail: -J-e,5 4 io �o� ar-,? C-0 141
GENERAL CONTRACTOR: (if different from applicant)
General Contractor: 40�t?rq 1?00-r.-)LA
Mailing Address: 1FOO L I ??A -Acl.< W rE A
City/State/Zip: _Z :Z
Phone #: 0
E-mail: 1-0-4-0-4 I-VO-P A-4 CO Ot
STATE UBI #: o';Z "-7 ID 61 116
CITY OF EDMONDS BUSINESS LICENSE #: 10- 04,997
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION
L C- L o -A e- f - r * 617.2 14 S' 61
Office Use Only
TYPE OF PERMIT (Provide Details on Page 2)
El Accessory Structure/ 0 Addition
Detached Garage
El Demolition
0 Mechanical
El New Single Family / Duplex
El Plumbing
El Fire Sprinkler
El Remodel
El New Commercial/ Mixed Use
aw'Re-Roof
El Signs
0 Tank
El 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: E'K' q'90
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLILAI 1UN
Basement sq ft: Finished 0 Unfinished 0
ist Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
Co ye-(- e �k �,.c
r& o c w -tA A,1 eda
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
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: Yes 0 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 Qty
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)
Qty 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 done? Y / N
PSCAA Case #:
Critical Areas Determination:
Study Required 0 Conditional Waiver EJ Waiver 0
Fill in Place 0 Fill Material:
Removal 0
Size of Tank (Gallons)
Critical Areas Determination:
Study Required 1:1 Conditional Waiver El Waiver El
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No El
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 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.
Copperstone Condominium Owners Association
1284 th Avenue S., #204
Edmonds, WA 98020
July 3, 2019
To Whom It May Concern:
On behalf of the COA this letter serves to authorize Loberg Roofing Company to perform work on the
exterior of the building located at 128 4 1h Avenue S. in Edmonds.
Sincerely,
ia+i,e,t Zepa
Board Secretary
Copperstone COA