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FIR2020-0089_City_Application_10.26.2020_7.26.18_AM (2)'nc. 18y%j BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements go to: www.edmondswa.gov. To apply for permits, schedule inspections, or check application status go to: www.mybuildingpermit.com JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 6801 N Meadowdale Rd Parcel: 00513100008401 Lot /Unit/Suite #: N/A Subdivision: N/A BUSINESS OR PROPERTY OWNER: Name: Meadowdale Community Club Mailing Address: 7110 210th St SW City/State/Zip: Edmonds, WA 98026 Phone #: 425-760-3334 Email: larry.lafave@edmondswa.gov OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? Yes © 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 of Applicant: ADT Commercial / Stephen Price Mailing Address: 600 Oaksdale Ave SW Suite 100 City/State/Zip: Renton, WA 98057 Phone #: 425-970-4359 E-mail: ssprice@adt.com GENERAL CONTRACTOR: (If different from applicant) General Contractor: N/A Mailing Address: N/A N/A City/State/Zip: Phone #: N/A E-mail: N/A STATE UBI #: 602805295 CITY OF EDMONDS BUSINESS LICENSE #: 602805295 WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: ADTCOCL801 UQ // 3-31-22 Office Use Only TYPE OF PERMIT (Provide ❑ Accessory Structure/ Detached Garage Details on Page 2) Addition Demolition Mechanical New Single Family/Duplex Plumbing Fire Sprinkler Remodel New Commercial/Mixed Use ❑ Re -Roof ❑ Signs ❑ Tank ❑ Tenant Improvement ❑ Other 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: 700 PROPOSED.. FOR THIS APPLICATION Basement scl ft: Finished❑ Unfinished ❑ 1st Floor, scl ft: 2nd Floor, scl ft: Garage/Carport:, sci ft: Deck/Covered Porch/Patio: # of NEW Bedrooms: # of NEW Bathrooms: PROJECT Covert existing POTS line to cellular communication. 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. Print Name: Stephen Price Price, Stephen Dgd.l1ys1gnetlbyPrO Stephe r,spbC. 10/22/20 Signature: [ssprice] Date 20201026072013-07'00' Date COMMERCIALGENERAL 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: CONNECTION COUNTSd or re piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: COUNTSMEDICAL GAS, AIR VACUUM Relocated or re piped) 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 GRADE/FILL/EXCAVATE 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.