20170119161506.pdfuITY OF EDMONDS
1215TH AVENUE NORTH -'EDMONDS, WA 98020
t PHONE:"(425) 771-0220 FAX: (425) 771-0221'
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Parcel No: 00713300000400'
CARLIN L MCKINLEY CARLIN L MCKINLEY CARLIN L MCKINLEY
PO BOX 2358 PO BOX 2358 PO BOX2358
LYNNWOOD, WA 98036 LYNNWOOD, WA 98036 LYNNWOOD, WA 98036
(425)478-5200 (425)'478-5200(425)478-5200
LICENSE 4: _ _ EXP:
CONSTRUCT 21) 1MERS'IN EXISTING HOME, NEW ROOF. REPLACE DECK SURFACE APPROX 24' X"10' W/ TREATED 2X4S
AND REPLACE LEDGE ALL WORK SUBJECT TO FIELD INSPECTION.
VALUATION:` $7,00000
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 HISMER DEPUTY AND ALL FEES ARE PAID,,
Signature r Prinf 1 � r Date ` Released By bate
IT IS 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/ IRCI 10.
ONLINE APPLICANT ASSESSOR I OTHHTi
STATUS: ISSUED BLD20170090
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
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 exempt ,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
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 fromthe issuance for;this permit. Issuance ofthis 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 19.00005(A)(6)'
When calling for an inspection please leave the
•; B-Roof Sheathing
• B-Framing
• B-Insulation/Energy
•' -B-Building Final
NT L1 5" 672-5755 = RECYCLING I 275-4801
n: Permit Number, Job Site Address, Type of Inspection being
ved, and whether you' efOr morning or. afternoon.
t t ta; a
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
s 1 9 121 5's Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 A Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
i
PROJECT ADDRESS (St.. � r d Suite # City State, Zip): Parcel #:
Subdivision/Lot #:
APPLICANT:
C K 11y
Address (Street, City, State, Zip): t
PROPERTY OWNE4:,
l P4.
Address (Street, City, State, Zip):
LENDING AGENCY:
Address (Street, City, State, Zip):
CONTRACTOR:*llf� el�f
Address (Street, City, State, Zip):
Project Valuation: $ ^ ovi
Phone:: � Fax:
d— -I.
/E-Mail Address:
Phone: Fax:
E-Mail Address:
Phone: I Fax:
E-Mail Address:
Phone: Fax:
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 Off ce at 425.775.2525 1 City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK.1°"t�"
PROPOSED NEWSQUARE FOOTAGE FOR THIS PROJECT:
Basement: . ft. Select Basement Type: Finished
I" Floor: _ _.—s . ft. Gara e/C ort:
2° Floor: s . ft. Deck/Cvrd Porch/Patio:
Unfinished
ft.
. ft.
Bedrooms # Full-3/4 Bath # Half -Bath # Other: —sq.
ft.
Fire Sprinklers: YesM No7l I Retaining Wall: Yes M No
Grading: Cut cu. yds. Fill cu.yds. I 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 properly owner to submit a permit application to
Print Name:
the City o Edmonds. L "
1AR+-- 1" CMK, Owner �Agent/Other E] (specify):
C ✓ 1'3 l
" d ..,Date>
Signature:: t
� �� _..-_
FORM A LABuilding New Folder 201000NE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014
V tJ
DEVELOPMENT SERVICES
r ?�Y
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
s
121 5`b Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 ft Fax 425.771.0221
Equipment Type
MECHANICAL
Appliance/Equipment Information (new and relocated) Total #
Furnace Gas #,,J
Elec #_,,Other:,_
# BTUs: <100k_ >100k_ Location(s)
Air Handler / VAV
(circle selected) Gas #
Elec # Other:
_ #_CFM: <lOk_ >lOk Location(s)
AC / Compressor /
Boiler / Heat Pump / Gas #—Elee
# ]th r:
# BTUs: <100k, 100k-500k, 500k-1Mil
Roof Top Unit HP:
<39 3-15,
15-30 Location(s)
(circle selected)
Hydronic Heating Gas #_Elec
#_In -Floor
_Wall Radiant,,,,, -, Boiler BTUs: Location ......
Exhaust Fans (single Bath #_Kitchen
duct)
#_Laundry # —0then #
Fireplace Gas #Elec
#Other:
# Location(s)
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated) Total #
AC Unit
BTUs:
Location(s):
Furnace
BTUs:
Location(s): ITITIT_� IT IT ITIT ITITIT
Water Heater
BTUs:
Location(s): uu
Boiler
BTUs:
Location(s): __
Other:
BTUs:
Location(s).--..-
Fireplace/Insert
BTUs:
Location(s):.
Stove/Range/Oven
a. �..�,,,,���
•.•._�....__..._
Dryer
_W
Outdoor BBQ
TOTAL OUTLETS
PLUMB
Fixture Type (new and relocated)
ING' FIXTURE COUNT
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, ncDA, AVB)
Water Heater Tankless? Yes
❑ No ❑
Hydronic Heat in: Floor Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A LABuilding New Folder 201000NE & x-ferred to L-Building-New drive\Form A2014.doex Updated: 1/17/2014