BLD20110273.pdfof Elp
STATUS: ISSUED 6/13/2011
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*
Expiration Date: 6/13/2012
Parcel No: 00689500003200
_ N Yro�ect Aaaress: L3 /LO 1U / tri YL W. LV1V1V
EVGENIY GOUSSEV EVGENIY GOUSSEV EXEMPT FROM CONTRACTOR
23726 107TH PL W 23726 107TH PL W
EDMONDS, WA 98020- 52 EDMONDS, WA 98020- 5
(206) 819-2439 Ext. ( ) - Ext. ( ) - Ext.
LICENSE M: EXP:
CONVERTING PORTION OF GARAGE TO RECREATION ROOM.
VALUATION: $10,000.00
h(^?' dt 3.2>Y 5-wl C014L, V-6 12-11gI/i
PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alteration/Remodel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
FENCE: N ( 0 X 0 FT.)
OTHER: N ----- OTHER DESC:
OCCUPANT LOAD:
CODE: 09
ZONE: RS -8
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT k:
7BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
LOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK
REQUIRED: PROPOSED:I REQUIRED: PROPOSED: RE UIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O I REQUIRED: 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,
IS APPLICATION IS NOT PERMIT UNTIL�� �Bc,TeHU BUILDING OFFICIAL OR HIS/HER DEPUTYAND ALL FEES ARE PAID. /�
lanature -Print Name , Date 3 Refeasid By J I Date
ATTENTION
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 UBC 109/ IBC I 10/ IRC I 10
r ,
ONLINE APPLICANT ASSESSOR
�G17�Iz,
OTHER
STATUS: ISSUED
BLD20110273
• The owner is aware that they DO NOT have approval for an ACCESSORY DWELLING UNIT (ADU). The requirements
for ADUs is contained in Edmonds Community Development Code (ECDC) Chapter 20.21. An ADU as defined in ECDC
21.05.015 is PROHIBITED until an ADU permit is first approved. An ADU permit is a special type of land use permit
(conditional use permit) which cannot be approved unless all of the criteria in ECDC 20.21 are met. No more than one single
family as defined in ECDC 21.30.0 10 will reside on the single family residential property. For clarification, the space in
question will be used as a "rec room."
• Obtain Electrical Permit from State Department of Labor & Industries. 425-290-1309
• 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 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.
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 (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720
PUBLIC WORKS 425) 771-0235 1 PRE-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 -Slab Insulation
• B -Plumb Ground Work
• B -First Floor Framing
• B -Plumb Rough In
• B -Mechanical Rough In
• B -Framing
• B -Wall Insulation/Caulk
• B-Insulation/Energy
• B-Sheetrock Nail
• B -Building Final
�y°,F E°"'Inspection Comments
BLD20110273 04 - Alteration/Remodel
Applied: 04/18/2011 Issued: 06/13/2011
Inc. 1 R90
Address: 23726 107TH PL W, EDMONDS
INSPECTION
DATE.
1118 - B -Slab Insulation
06/14/2011
Comment:
1120 - B -Plumb Ground Work
Comment:
1122 - B -First Floor Framing
Comment:
1126 - B -Plumb Rough In
Comment:
1130 - B -Mechanical Rough In
Comment:
1142 - B -Framing
06/17/2011
Comment:
1144 - B -Wall Insulation/Caulk
08/30/2011
Comment:
1146 - B-Insulation/Energy
Comment:
1150 - B-Sheetrock Nail
08/30/2011
Comment: Main room only, not bath at this time.
1158 - B -Building Final
Comment:
Expires: 06/13/2012
INSPECTOR ACTION
STEINIKE CMP
STEINIKE CMP
STEINIKE CMP
STEINIKE PAR
9/17/2012 3:08:27 PM 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).
0 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).
0 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 IS day of APV—L , 20 11.
PROPERTY OWNER/AUTHORIZED
PERS
.�
Signature
cvpsf� (�R
Print'llame
WITNESS
d1&AWUyK_' -1
Si ature
l lel
dC4 - WK 6U (s
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVLSED 7/07