BLD20110119.pdfV
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° CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
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PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 2/22/2011
Pernut #: BLD2011011,9
Expiration Date: 8/22/2011T Project Address: 109 4TH AVE N, EDMOND
Parcel No: 00434400600100
AVENUE SOUTH PROPERTIES L THIRD THIRD AVENUE SOUTH PROPERTIES COMMERCIAL EXEMPTION TAKEN
229 3RD AVE S ST 301 229 3RD AVE S ST 301
EDMONDS, WA 98020- EDMONDS, WA 98020-
(425).954-4085 Ext. (425) 954-4085 Ext. ( ) - Ext.
LICENSE #: EXP:
JOB DESCRIPTION
DEMOLISH CARPET, NON-BEARING WALLS, DROP CEILING. M won
VALUATION: $0
CompL"ED
PERMIT TYPE: Commercial
PERMIT GROUP: 24 - Secondary/Interior Demo
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: N ( 0 X 0 FT.)
CODE:
OTHER: N ------- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
:EQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED:
{EIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
ETBACK NOTES:
1 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 TEES ARE PAID.
Signature Print Name Date Released By T 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, UBCI09/ IBCI 10/ IRCI 10.
= ONLINE = APPLICANT = ASSESSOR 0 OTHER
STATUS: ISSUED
• *Pre -inspection required.
*Street to be cleaned of debris.
*Dump at approved dump site only.
BLD20110119
• 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.
• 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 7:00am 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
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 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 EC DC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 1 EVGINFF1tING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720
PUBLIC WORKS (425) 771-0235 1 PR&TREATMENT (425)672-5755 1 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 Prefereed, and whether you prefer morning or afternoon.
• B -Final Demolition
• B-PRE-DEMOINSPECTION
��°� E°MOti
Inspection
Comments
N
BLD20110119
24 - Secondary/Interior Demo
Applied: 02/22/2011
Issued: 02/22/2011 Expires:
12/09/2011
Address: 109 4TH AVE N, EDMONDS
,INSPECTION
DATE INSPECTOR
ACTION.
1104 - B -Final Demolition
12/06/2011 LAWLER
CMP'
Comment:
1158 - B -PRE -DEMO INSPECTION 03/08/2011 STEINIKE CMP
Comment:
12/6/2011 8:19:50 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORM D
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to the City of Edmonds that:
❑ Value of work under $500.00. The aggregate contract price of labor and materials and all
other items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that lie/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090(9).
❑ Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 18.27.090(11).
❑ Work performed personally on own property. Anyone personally working on property
he/she owns, or at which he/she resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
Use of own employees. Property owner using him/herself or his/her own employees to
perform maintenance, repair, and, alteration work in or upon his/her own property. RCW
18.27.090(13).
❑ Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
❑ Other. Specify which provision of RCW 18.27.090 applies:
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this �_ day of '. -e b_, 20�.
PROPERTY OWNER/AUTHORIZED
PERSON
4 ' z9a&
Signature
/f /M
Print Name
WITNESS
ME,.,K i'Jv. / , , //i
Signature
&6%7�
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07