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DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
s,i 18'i� 121 5th Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 0 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
8407 200TH STREET SOUTHWEST, EDMONDS, WA 98026
27041900210700
Subdivision/Lot #:
Project Valuation: $
SEC 19TWP27 RGE 04RT-25A)S 70FT OF N 210FT OF TH PTN NE1/4NW114 DAF BEG BE COR SO SUB TH NOI-0722WALG E LN 33345Fi TH S89-0241W1 A
$16,329.31
APPLICANT:
Phone:
Fax:
CHLOE BARKER / NW PERMIT INC
360-945-2787
Address (Street, City, State, Zip):
E-Mail Address:
9808 31 ST AVE SE, EVERETT, WA 98208
HD@NWPERMIT.COM
PROPERTY OWNER:
Phone:
Fax:
JOHN WILLARD
(360) 387-4113
Address (Street, City, State, Zip):
E-Mail Address:
8407 200TH STREET SOUTHWEST, EDMONDS, WA 98026
CAMANOMENZ@GMAIL.COM
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
HOME DEPOT USA INC
360-945-2787
Address (Street, City, State, Zip):
E-Mail Address:
2455 PACES FERRY RD, ATLANTA, GA 30339
HD@NWPERMIT.COM
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
HOMED**088RH 7/17/20
City Business License #/Exp. Date:
doing work in the City. Contact the City Clerk's Office at 425.775.2525
NR-025556 ISSUED 12/31/2018
DETAIL THE SCOPE OF WORK: Replacing 17 windows like -for -like. no size or structural change.
PROPOSED NEWSQUARE FOOTAGE
FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished LJ Unfinished
I" Floor: sq. ft.
Garage/Carport: sq. ft.
2n Floor: sq. ft.
Deck/Cvrd Porch/Patio: sc . I1.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes Ll No 17
1 Retaining Wall: Yes
No 71
Grading: Cut cu. yds. Fill cu. ds.
I Cut/Fill in Critical Area: Yes L No
I declare under penalty ofperjury laws that the information I haveprovided 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: CHLOE BARKER
Owner ❑ Agent/Other W (specify): CONTRACTOR'S AGENT
Digitally signed by Chloe Barker
Signature: Chloe Barker Date: 2018.06.04 19:07:27 -07'00'
Date: 01/14/2019
FORM A L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1 /17/2014
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DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
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121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 A Fax 425.771.0221
Equipment Type
Appliance/Equipment Information (new and relocated) Total #
Furnace
Gas #
Elec #_Other:
#— BTUs: <100k_ >100k _ Location(s)
Air Handler / VAV
(circle selected)
Gas # —
Elec # Other:
—
#—CFM: <10k >10k— Location(s)
AC / Compressor /
Boiler / Heat Pump /
Gas #—Elec
#_Other:
# BTUs: <100k, 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 BTUs: Location
Exhaust Fans (single
Bath #
Kitchen # Laundry
# #—
duct)
—Other:
Fireplace
Gas #
Elec # Other:
# Location(s)
Dryer Duct
FUEL GAS
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
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 ❑ No ❑
Hydronic Heat in: Floor ❑ Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORMA L:\Building New Folder 2010\130NE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1 /17/2014
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Order Confirmation
Order Details
Ship To:
THD/SEATTLE-Lynwood West
Hansen Bros
2810 Lincoln Way
Lynnwood, WA 98087
Job Name: WILLARD
P.O. Number: 10861642
Simonton Order Number: 10250009
Expected Delivery Date: 01/08/2019 - 01/10/2019
Ordered
Ln No Qty Ord Description
35 1/2" (T) X 71 1/2" (T) Clear Value White PC over SL; Tip -to -
Tip Oriel 53.625"; Block Frame; T-Mulled; Energy Star North
Central; Supercept; ProSolar Low E; Argon Gas; Double
Glazed; Temper Bottom All; Double Strength (1/8"); Half Screen
Fiberglass Roll -Formed Scr Mold; Y2 Alum Lok Ra/St Steel
Stayba; Tape Applied (U1=107"); DP:20; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
Clear Value White Picture; Tip -to -Tip; Block Frame; T-Mulled;
Energy Star North Central; Supercept; ProSolar Low E; Argon
Gas; Double Glazed; Double Strength (1/8"); 00 No
Reinforcement; Tape Applied (UI=90");
Clear Value White Slider (XO); Tip -to -Tip; Block Frame; T-
Mulled; Energy Star North Central; Supercept; ProSolar Low E;
Argon Gas; Double Glazed; Temper All All; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; 00 No
Reinforcement; Tape Applied; One Cam White; Plain; Corrosion
Resist Roller/Glide (UI=53");
2 1 35 1/2" (T) X 71 1/2" (T) Clear Value White PC over SL; Tip -to -
Tip Oriel 53.625"; Block Frame; T-Mulled; Energy Star North
Central; Supercept; ProSolar Low E; Argon Gas; Double
Glazed; Temper Bottom All; Double Strength (1/8"); Half Screen
Fiberglass Roll -Formed Scr Mold; Y2 Alum Lok Ra/St Steel
Stayba; Tape Applied (U1=107"); DP:20; U-Factor:.30;
Room ID
Ln No Qty Ord Description
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
2 1 Clear Value White Picture; Tip -to -Tip; Block Frame; T-Mulled;
Energy Star North Central; Supercept; ProSolar Low E; Argon
Gas; Double Glazed; Double Strength (1/8"); 00 No
Reinforcement; Tape Applied (UI=90");
Clear Value White Slider (XO); Tip -to -Tip; Block Frame; T-
Mulled; Energy Star North Central; Supercept; ProSolar Low E;
Argon Gas; Double Glazed; Temper All All; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; 00 No
Reinforcement; Tape Applied; One Cam White; Plain; Corrosion
Resist Roller/Glide (UI=53");
3 1 35 1 /2" (T) X 71 1 /2" (T) Clear Value White PC over SL; Tip -to -
Tip Oriel 53.625"; Block Frame; T-Mulled; Energy Star North
Central; Supercept; ProSolar Low E; Argon Gas; Double
Glazed; Temper Bottom All; Double Strength (1/8"); Half Screen
Fiberglass Roll -Formed Scr Mold; Y2 Alum Lok Ra/St Steel
Stayba; Tape Applied (U1=107"); DP:20; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARS region(s): North
Central.
3 1 Clear Value White Picture; Tip -to -Tip; Block Frame; T-Mulled;
Energy Star North Central; Supercept; ProSolar Low E; Argon
Gas; Double Glazed; Double Strength (1/8"); 00 No
Reinforcement; Tape Applied (UI=90");
3 1 Clear Value White Slider (XO); Tip -to -Tip; Block Frame; T-
Mulled; Energy Star North Central; Supercept; ProSolar Low E;
Argon Gas; Double Glazed; Temper All All; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; 00 No
Reinforcement; Tape Applied; One Cam White; Plain; Corrosion
Resist Roller/Glide (UI=53");
Room ID
Ln No Qty Ord Description
Room ID
4 1 59 1/2" (T) X 47 1/2" (T) Clear Value White Slider (XO); Tip -to- Bedroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (U1=107"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
5 1 59 1/2" (T) X 47 1/2" (T) Clear Value White Slider (XO); Tip -to- Bedroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (U1=107"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARS region(s): North
Central.
6 1 29 1/2" (T) X 71 1/2" (T) Clear Value White Single Hung; Tip -to- Bedroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Temper Bottom
All; Double Strength (1/8"); Half Screen Fiberglass Roll -Formed
Scr Mold; Y2 Alum Lok Ra/St Steel Stayba; Tape Applied; Two
Cam White; Plain; Slotted Cavity Plug; (Ul=101"); DP:20; U-
Factor:.29; SHGC:.30; Unit qualifies for ENERGY STARE
region(s): North Central.
7 1 29 1/2" (T) X 71 1/2" (T) Clear Value White Single Hung; Tip -to- Bedroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Temper Bottom
All; Double Strength (1/8"); Half Screen Fiberglass Roll -Formed
Scr Mold; Y2 Alum Lok Ra/St Steel Stayba; Tape Applied; Two
Cam White; Plain; Slotted Cavity Plug; (U1=101"); DP:20; U-
Factor:.29; SHGC:.30; Unit qualifies for ENERGY STARE
region(s): North Central.
8 1 47 1/2" (T) X 17 1/2" (T) Clear Value White Slider (XO); Tip -to- Bathroom
Tip; Block Frame; Energy Star North Central; Supercept;
ine Item
Ln No Qty Ord Description Room ID
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; One Cam White; Plain;
Corrosion Resist Roller/Glide (UI=65"): DP:15. U-Factor:.30:
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
47 1/2" (T) X 17 1/2" (T) Clear Value White Slider (XO); Tip -to- Bathroom
Tip; Block Frame; Energy Star North Central; Supercept;
PrnSnlar I rnN F• Arnnn C;ac nniihla (_�In7prl• Tamnar All All;
Double Strength (1/8"); Half Screen Fiberglass Roll -Formed Scr
Mold; Y2 Alum Lok Ra/St Steel Stayba; Tape Applied; One Cam
White; Plain; Corrosion Resist Roller/Glide (UI=65"); DP:15; U-
Factor:.30; SHGC:.31; Unit qualifies for ENERGY STARE
region(s): North Central.
10 1 47 1/2" (T) X 41 1/2" (T) Clear Value White Slider (XO); Tip -to- Bathroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (UI=89"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
11 1 71 1/2" (T) X 81 1/2" (T) (60610P) 6200 White Contemporary Dining
Door (2-Lite) Left Opening (XO); Assembled PD; Int. Handle
Powder Coat White; Ext. Handle Powder Coat White; Tip -to -Tip;
Block Frame; Intercept; ProSolar Low E; Argon Gas; Double
Glazed; Temper All All; Double Strength (1/8"); Half Screen
Fiberglass Extruded Screen Mold Wrap Screen Separate; E5 All
Stiles(SL/EV); Tape Applied; Non -Keyed MultiPoint; Corrosion
Resist Roller/Glide (U1=153"); DP:20; U-Factor:.30; SHGC:.31;
Unit qualifies for ENERGY STARE region(s): Northern, North
Central.
12 1 71 1/2" (T) X 81 1/2" (T) (60610P) 6200 White Contemporary Bedroom
Door (2-Lite) Left Opening (XO); Assembled PD; Int. Handle
Powder Coat White; Ext. Handle Powder Coat White; Tip -to -Tip;
Ln No Qty Ord Description Room ID
Block Frame; Intercept; ProSolar Low E; Argon Gas; Double
Glazed; Temper All All; Double Strength (1/8"); Half Screen
Fiberglass Extruded Screen Mold Wrap Screen Separate; E5 All
Stiles(SL/EV); Tape Applied; Non -Keyed MultiPoint; Corrosion
Resist Roller/Glide (U1=153"); DP:20; U-Factor:.30; SHGC:.31;
Unit qualifies for ENERGY STARS region(s): Northern, North
Central.
13 1 47 1/2" (T) X 23 1/2" (T) Clear Value White Slider (XO); Tip -to- Bathroom
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; One Cam White; Plain;
Corrosion Resist Roller/Glide (UI=71"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
14 1 35 1/2" (T) X 35 1/2" (T) Clear Value White Slider (XO); Tip -to- Living
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (UI=71"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
15 1 35 1/2" (T) X 35 1/2" (T) Clear Value White Slider (XO); Tip -to- Living
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (UI=71"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
16 1 35 1/2" (T) X 35 1/2" (T) Clear Value White Slider (XO); Tip -to- Living
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
Ln No Qty Ord Description
Lok Ra/St Steel Stayba; Tape Applied; Two Cam White; Plain;
Corrosion Resist Roller/Glide (UI=71"); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARS region(s): North
Central.
17 1 59 1/2" (T) X 35 1/2" (T) Clear Value White Slider (XO); Tip -to -
Tip; Block Frame; Energy Star North Central; Supercept;
ProSolar Low E; Argon Gas; Double Glazed; Double Strength
(1/8"); Half Screen Fiberglass Roll -Formed Scr Mold; Y2 Alum
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Corrosion Resist Roller/Glide (UI=951); DP:15; U-Factor:.30;
SHGC:.31; Unit qualifies for ENERGY STARE region(s): North
Central.
Room ID