1727_001.pdf•' c . 1-6-1
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: http://www.edmondswa.gov/
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address:
Parcel:
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name:
Mailing Address:
City/State/Zip: _
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes V No
I own, reside in, or will reside in the completed structure.
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name ofApplicant:
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Mailing Address: UH b 1 �1,, i t and • 2
City/State/Zip: C,Y\0 �1�V►\{�STI �{��J���
Phone #: 1 09 . UYO • (DL4D3 �n
E-mail: 0_0A i'.1r@.+A. W n1!a S I+ t
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: 0uuff4 V_ b d
Mailing Address:
City/State/Zip: _
Phone #:
E-mail:
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
CITY OF EDMONDS BUSINESS LICENSE #:
Permit#:
(ProvideDetails on Page
❑ Accessory Structure/
❑ Addition
Detached Garage
❑ Demolition ❑ Mechanical
❑ New Single Family / Duplex ❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
El Re -Roof
El New Commercial/ Mixed Use
M//Signs
❑l Tank
❑ Tenant Improvement
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Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: - 0 I ��� 1
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:CsiGIA S
PROJECT•
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I certify 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. vsNr�-ir`D �q 6�D1Y� �4J>ti ��c�J�1��j�Yf'ti
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Print Name:
Signature: Date
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GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: Yes ❑ No ❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler/VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE .. ..
Qty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other: �7n
CONNECTION.. ...
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stave/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated . .
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material:
Removal ❑ Size of Tank (Gallons)
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.
From the Desk of Amber Sears
July 3, 2018
RE: McDonald's Menu Boards at
Attached you will find a submission pertaining to the menu board project for McDonald's located in your jurisdiction. The
details of this project are outlined in the plans. Please do not hesitate to contact me should you need anything else to
process this permit application package.
I have included building, electrical and sign permit applications whenever possible, if one is not needed, please discard it.
The contractor for this project is U4 ' CJY bI d . We need to obtain all necessary approvals
to remove and replace the existing menu boards. The menu boards proposed are smaller than what is currently in place.
o Please contact me for the fees and I will have a check sent in right away.
o Please contact me if you need additional drawings or additional permit applications.
o Please contact me if you need any type of information that would help process the permits.
I have been hired to process the permit application(s) that are enclosed. I am the point of contact for any information
regarding the enclosed application(s). I will facilitate communication with the contractor, owner and/or responsible
parties. I will provide any fees necessary and shipping labels if needed to mail issued permit(s). If you require any
additional information please call me. Please do not contact anyone else as the client(s) has contracted me to handle the
procurement of said permit(s). I am no different than a secretary hired to help with a project, please view my role as such.
I sincerely thank you in advance for your cooperation. I can be reached at.amber@etd.website.
Best 7
ards,
Amber Sears
Permit Manager
Enclosures: Permit Application (s) •—G �/iI 1C 1 r
Coates Permit Package �J
Site Plan
1510"Nu Ims
6487 Hilliard Dr. Canal Winchester OH 43110
07x 3
509-680-6423
Single - Sign Face - 4' 1 % " H x 2' 5 1/8" W
Qty of Single Menu Boards C;�
Double — Sign Face — 4' 1 5/8" H x 4' 10" W
Qty of Double Menu Boards _13-_
10.06 sq. ft Height 5' 11'/"
19.79 sq. ft. Height 5' 115/8"