BLD20171828FINAL
CITY OF EDMONDS...
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 03/20/2018
Expiration Date: 03/20/2019
Parcel No: 00473700002300
HUPF PROPERTIES
PO BOX 2932
KIRKLAND, WA 98083
(425) 23 1-4548
HUPF PROPERTIES
CIO AARON ROSS
17927 75TH PL W
EDMONDS, WA 98155
(425)231-4548
LICENSE #: EXP:
INTERIOR REMODEL
PLUMBING AND MECHANICAL INCLUDED
VALUATION: $35,000
PERMIT TYPE: Residential
PERMIT GROUP: 04 - Alteration/Remodel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.
CODE:2015
OTHER: ------- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
In
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
LOT #:
BNSEMENT: 0 1ST FLOOR: 0 2ND`FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE'0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
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 DOING THE WORK AUTHORIZED THEREBY, NO
PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPENSATION
INSURANCE AND RCW 18:27.
THIS JON IS NOT A PE
RMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER ND ALL FEES ARE PAID.
S Sri Print Name Date Relea By Date
ATTENTION
ITIS 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.
FIRE APPLICANT ASSESSOR CiIY
STATUS: ISSUE
BLD20171828
• 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 fromtemporary construction sites as a result ofconstruction activity are exempt fromthe 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.I20.
• 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, enployees, and agents from any and all claims for damages of
whatever nature, arising 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 PERMIT AUTHORQES 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
-
ENGINEERING (425) 771-0220 EXT. 1326
1. Go to: www.edmondswa.gov
Building Department Inspections
2. Then: Services
are now scheduled online. If you
FIRE (425) 775-7720
3. Then: Pen-nits/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 have one already, create a
assistance during office hours.
login (upper right hand comer)
(425) 771-0220
RECYCLING (425) 275-4801
6: Schedule your inspection
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 mominq or afternoon.
• B-Plumb Rough In
• B-Gas Test/Pipe
• B-Mechanical Rough In
• Shower pan test
• B-Fire Blocking / Stopping
• B-Framing
• B-Insulation/Energy
• B-Building Final
• B-Other
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-
0 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).
Tie/she
ork performed personally on own.property. Anyone personally working on property
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 U ee , 201') .
PROPERTY OWNER/AUTH D
PERSON��
Print Name
WITNESS.
Si ature
b ada VIOW46o C:2�
Print Name
LATEMMUILDINMHANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07
J DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5 h Avenue N, Edmonds, WA98020
City of Edmonds Phone 425.771.0220 g Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
17 7 l'I e5a- ' ,rnc,,,A_a>
Parcel #:
Subdivision/Lot #:
Project Valuation: $
35 , UUCD
APPLICANT:
Phone:
`/a6— 9,3x L1 9
Fax:
Address (Street, City, State, Zip):
E-Mail Ad ess
PROPERTY OWNER:
Phone:
Fax:
Address Street, City Siate�
1,7 7 uL es�- G'�.nl►� �u,
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
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: 2e o A�c?� Ce p\Cice '� ti e3 "cab c o,h,te� 5
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement: s . ft.
Select Basement Type: Finished Unfinished
15` Floor: s . ft.
Garage/Carport: s . ft.
2❑d Floor: s . ft.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: s . ft.
Fire Sprinklers: Yes
LJ No
Retaining Wall: Yes No El
Grading: Cut cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes LJ 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. j
Print Name: Owner 0 Agent/Other Q (specify):
Signature: � � Date: aa" t✓mac- :1y0-1
FORM A LABuilding New Folder 201000NE & x-ferred to L Building -New driveTorro A2014.docx Updated: 1/17/2014
OF EDAf
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a
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
Est. 1 169�)
121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 4 Fax,425.771.0221
Equipment Type
Appliance/Equipmeat Information (new and relocated)
Total #
Furnace
Gas #_Elec # Other:
#_BTUs: <100k_>100k_ Location(s)
Air Handler / VAV
(circle selected)
Gas #_Elec # Other:
#_CFNI: <10k_>10k_ Location(s)
AC / Compressor /
Boiler / Heat Pump /
Gas #_Elec #_Other:
# BTUs: <l0#k, 100k-500k, 500k-1Mil
Roof Top Unit
HP; <3, 3-15,
15-30 Location(s)
(circle selected)
Hydronic Heating
Gas #_Elec #_In -Floor
_Wall Radiant_ Boiler BTUsLocation
Exhaust Fans (single
Bath #Kitchen # y
�Lallndr # Other:
duct)
-#—
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):
Water Heater
BTUs:
Location(s):
Boiler
BTUs:
Location(s):
Other:
BTUs:
Location(s):
Fireplace/Insert
BTUs:
Location(s):
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
'
t
i
Fixture Type (new and relocated)
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, DCDA, AVB)
Water Heater Tankless? Yes Noo
Hydronic Heat in: Flooro Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for waterlice dispenser)
Other:
FORM A LABuilding New Folder 201000NE & x-ferred to LrBuilding-New driveTorm A2014.docx Updated: 1/17/2014
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