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BLD20150768.PDFCITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 Expiration Date: Parcel No: 00513100006300 PROPERINOWNER APPLICANT CONTRACTOR DAVID & STEWART DEBORAH DAVID & STEWART DEBORAH DAVID & STEWART DEBORAH FRITSCHEN FRITSCHEN FRITSCHEN 19925 13TH DR SE 19925 13TH DR SE 19925 13TH DR SE BOTHELL, WA 98012-7103 BOTHELL, WA 98012-7103 BOTHELL, WA 98012-7103 LICENSE #: EXP: MINOR WORK PERMIT TO COMPLETE WORK UNDER BLD2012-0822. CRAWL SPACE DUCTWORK AND PLUMBING IN 3 BATHROOMS. VALUATION: $1,500.00 6"ukk PERMIT TYPE: Residential PERMIT GROUP: 43 - Miscellaneous GRADING: N CYDS: 0 TYPE OF CONSTRUCTION: RETAINING WALL ROCKERY: OCCUPANT GROUP: OCCUPANT LOAD: FENCE: 0 X 0 FT CODE: 2012 OTHER: ------- OTHER DESC: ZONE: NUMBER OF STORIES: 0 VESTED DATE: NUMBER OF DWELLINGUNITS: 0 LOT #: BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0 BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 BEDROOMS:O BATHROOMS:O BEDROOMS:0 BATHROOMS:0 REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED: SETBACK NOTES: I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE 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 APPLIC�I'I1�JN I&�PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID, Print Name BY lS� 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. UBC109/ IBC 110/ IRCI 10. l ONLINE APPLICANT ASSESSOR OTHER %G STATUS: APPLIED BLD20150768 . 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 altemase 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 fromthe 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 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. INSPECTIONS 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) 1 BUII_,DING (425) 771-0220 EXT. 1333 FNGRODUNG (425) 771-0220 EXT. 1326 I FIRE 425 775-7720 PUBLIC WORKS 425) 771-0235 1 PR&TRFATM©VT 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-Mechanical Final • B-Building Final N DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION Fst 1 s9� 121 5`h Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 4 Fax 425.771.6221 PLEASE REFER.TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: Subdivision/Lot #: Project Valuation: $ APPLICANT: LWID Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: PROPERTY OWNER: AIMii�_E Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: CONTRACTOR:* v /1/ Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: *Contractor must have a valid City of Edmonds business license prior to doing work in the City. Contact the City Clerk's Office at 425.775.2525 WA State License #/Exp. Date: City Business License #/Exp. Date: DETAIL THE SCOPE OF WORK: •C/2/fi,�/L -; P1�G GlY%/'''� O /%ys 7/�LLri�T �O/✓ D� M��/�'/ � , CDo✓rv�G� /'�� u M B.�/�i6 �i X��i� .�N PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement: s . ft. Select Basement Type: Finished Unfinished ls` Floor: - -sq. ft. Gara e/C ort: s . ft. 2nd Floor: s . ft. Deck/Cvrd Poich/Patio: s . ft. Bedrooms # Full-3/4 Bath # Half -Bath # Other: sq. ft. Fire S rinklers: Yes NoT7 Retaining Wall: Yes No Grading: Cut cu. yds. Fill cu.yds. Cut/Fill in Critical Area: Yes U 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 property owner to submit a permit application to the City of Edmonds. Print Name: DV D 'SG G IB/ Owner u Agent/Other Q (specify): Signature: Date: Q , FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014 EXEMPTION FROM CONTF s CTOR REGISTRATION VERIFICnfION FORMI) 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 he/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). 21---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). 0 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). 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 DAMEDIATELY REVOKED AND ALL FEES PAID FORFEITED. DATED this L__— day of .� G2/L` , 2015 J��D o0 r 7 Print Name WITNESS Signature Print Name L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM D.DOCREVISED 7/07 3 2 a O co c. aNi U) I LU z U 0 0 W = o 0) a. °m a 0 �- °d � z _) ornO M Cf) 5` (D;Q(D� 4 d N N V a 9 V 0 v Z U) a