FIR2020-0059_City_Application_6.15.2020_4.29.49_PM'nc. 189'i
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edrnondswa.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingyermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 220 Railroad Ave. Edmonds, WA_
Parcel:
Lot /Unit/Suite #: Kitchen Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: EDMONDS WATERFRONT CENTER
Mailing Address: 220 Railroad Ave. Edmonds, WA
City/State/Zip: Edmonds, WA 98020
Phone #:
Email
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: N/A
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Alexander Gow Fire Equip.
Mailing Address: 1436 NW 53rd St.
City/State/Zip: Seattle, WA 98107
Phone #: 971-217-5546
E-mail: Jgualco@gowfire.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 601-291-837
CITY OF EDMONDS BUSINESS LICENSE #: NR-026034
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
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TYPE OF PERMIT (Provide
Details
❑Accessory Structure/
Addition
❑
Detached Garage
Demolition
Mechanical
❑ New Single Family/Duplex
❑ Plumbing
Fire Sprinkler
❑ Remodel
New Commercial/Mixed Use
Re -Roof
❑ Signs
❑ Tank
Tenant Improvement Other Ple"YeAl
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: $2,800
PROPOSED NEW SQUAREL,FOOTAGE'FOR. THIS APPLICATION;-
Basementsgft: Finished❑ Unfinished❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, scl ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECTe •
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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.
Print Name: Joshya Gualco
Signature: Date 6/15/2020
GENERAL • DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:(,D InM• Fire Sprinklers: Yes❑ NoF
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
•COUNTS
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 • d• •t
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 COUNTS• • • • -
BTUs Qty BTUs Qty
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert Other:
Furnace Other:
MEDICALCOUNTS
(New, Relocated orre 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
•.e
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.