ACCEPTED _____________
APPROVED _____________
ISSUED ________________
VARIANCE NO. __________
COND. USE NO. _________
SUB. DEV. NO.___________
DATE ________
DATE ________
DATE ________
DATE ________
DATE ________
DATE ________
10550 SE 27th Street
Beaux Arts Village, WA 98004
Kolke Consulting Group, Inc.
PROPERTY ADDRESS ________________________________________________________________________________________
PROPERTY OWNER ____________________________________________________
PHONE ___________________________
ADDRESS ___________________________________________________________
OWNER’S AGENT/COMPANY______________________________________________
PHONE ___________________________
ADDRESS ___________________________________________________________
EMAIL ____________________________
ARCHITECT/COMPANY __________________________________________________
PHONE ___________________________
ADDRESS ___________________________________________________________
EMAIL ____________________________
CONTRACTOR NAME ____________________________________________________
PHONE ___________________________
ADDRESS ___________________________________________________________
EMAIL ____________________________
LICENSE NO. _________________________ EXPIRES ______________________
TAX NO.___________________________
PROPERTY LEGAL DESCRIPTION (Attach separate legal description, if necessary)_____________________________________________
_______________________________________________ ASSESSOR’S PARCEL NO. __________________________________
ESTIMATED FAIR-MARKET VALUE OF PROJECT $___________________________________
Is work within 200 feet of Lake Washington Ordinary High Water Line? YES NO
Is the existing structure currently fire sprinklered? YES NO NA
Describe the nature of the proposed project:
List any building permits previously granted to the subject property (permit number and date):
Is there an existing nonconforming use? If so, please describe:
Has a variance been granted to this property? If so, please describe:
I certify under penalty of perjury that I am the owner of the above described property or the duly authorized agent of the
owner(s) acting on behalf of the owner(s) and that all information furnished in support of this permit application is true,
correct, and in the right number. I further certify that all applicable federal, state, county, and Town of Beaux Arts Village
requirements for the work authorized by this permit will be met
SIGNATURE _______________________________________________________ OWNER AGENT DATE _______________
This section to be completed by Town staff:
PLAN REVIEW FEE $ ________________
RECEIPT NO. _________
PLAN REVIEW DEPOSIT ________________
XMT ___________________
DATE ________
BALANCE DUE ________________
DSN ___________________
DATE ________
DOE ___________________
DATE ________
INSPECTION DEPOSIT ________________
HEAVY TRUCK FEE ________________
PERMIT FEE $________________
NO. ___________________
DATE ________
ST. BLDG. CODE FEE ________6.50____
XMT ___________________
DATE ________
RECEIPT NO. _________
TOTAL DUE AT ISSUE ________________
Form Name: Building Permit Application Last Update: 05/2014
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General Permit Conditions:
1. The owner or the owner’s agent may apply for a building permit by submitting this form with the necessary additional
documentation and plan review fee to the Beaux Arts Building Department.
2. All construction must conform to the requirements of the Town Building, Tree, and Zoning Codes found in BAVMC 15.05, 16.25,
and 18.10. Other federal, state, and local regulations may also apply. Stormwater Management Requirements in BAVMC 13.15
must be followed. It is the responsibility of the property owner to find out all applicable laws, codes, and regulations and comply
with them.
3. The permit card, approved plans, and other permit documents must be posted or available at the project site at all times when
authorized work is in progress. Work must start within 180 days of the permit issue date. Excavation or exterior construction must
be completed within one year of the permit issue date. This permit will expire if work is suspended or abandoned for a period of
180 days after the time work is commenced. Extensions may be granted by the Building Official when requested in writing.
4. Any changes to the planned construction or location of this project must be submitted to the Building Department for review prior to
the actual work taking place. Additional fees may be due before final approval of such revisions is granted.
5. During construction, work may not proceed until the Town building inspector has approved each stage of construction. Inspections
other than the final must be scheduled 24 hours in advance. A final inspection for new construction must be scheduled at least 3
days in advance. In addition, the Town building inspector may require special inspections. Typical building inspections include the
following; however, additional inspections may be required for your permit:
Foundation walls
Epoxy grouting
Slab insulation
Footing drains
Sheetrock nailing
Exterior shear
Floor sheathing
Roof insulation
Roof sheathing
6. Construction hours are as follows. These hours are STRICTLY enforced. A violation will result in a STOP WORK ORDER.
Monday through Friday 7 AM 6 PM
Saturday 8 AM 5 PM
Sunday and Holidays No Work Allowed
Out of courtesy to your neighbors, no construction work may take place except during these hours. This includes loading or
unloading equipment and materials, setting up for the day’s work, performing work that results in other noises that are
unreasonable for a residential area, etc.
7. Mechanical equipment is not permitted to be installed in the setbacks per BAVMC 18.10.080(8).
8. Contractors are responsible for parking vehicles on the subject property or other parking spaces along Town right-of-ways
available to the general public. Streets or driveways are not to be blocked by construction vehicles. If temporary street closure is
necessary for unloading or construction work, contact the Building Department at 425.269.6985 at least 24 hours in advance so
that affected neighbors can be notified.
9. Contractors are responsible for removing dirt and construction debris from the Town right-of-way and for protecting neighboring
properties from runoff or other damage from construction.
10. The property owner is responsible for informing all contractors, subcontractors, and their employees of the requirements for
construction and to ensure their compliance. All permits issued are conditioned upon compliance with any and all provisions of the
laws, ordinances, and codes in effect at the time the permit application was filed with the Building Department. Permits issued in
error or on the basis of incomplete or inaccurate information may be suspended or revoked. Upon inspection, work found to be
constructed in violation may be ordered removed and/or brought into compliance at any time the violation becomes apparent to an
official of the Town.
11. As the property owner, it is your responsibility to retain copies of all permit documents including the application, drawings, and
supporting documents, the permit card with inspection record, and any other paperwork or information that documents the type of
work performed and its permitted status.
12. Owners and contractors should code sales tax for job-related expenditures to STATE REVENUE CODE 1703.
13. The permit conditions listed here are general conditions only. Additional permit conditions may be imposed and will be attached to
your permit drawings.
I certify that I have read the general permit conditions listed above and that I understand that failure to comply with these and
any other permit conditions listed on the permit card or imposed during construction may result in a Stop Work Order.
SIGNATURE _______________________________________________________ OWNER AGENT DATE _______________
Form Name: Building Permit Application Last Update: 05/2014
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