Building Permit•M MERCIAL BLDG PermitCity
-
• • • •
J[M
121 5th Ave N, EdmondsPERMITNUM
980201 1
ww.edmondswa.gov
Type: COMMERCIAL BLDG Owner/ Business: CHELSEA RODGERS Status: ISSUED
Subtype: NEW TENANT IMPROVEMENT
Parcel No: 27033600102700 Site Address: 22815 EDMONDS WAY EDMONDS,WA 98020-5041
Applied: 1/28/2021
Subdivision: 005462, 005443, LLA 33-99-46 Lot: 0
Issued: 5/20/2021
Fire Sprinklers: No Lot Area: 16,552 Zoning: BP
Final:
Valuation: $275,000.00 Occupancy Type: B Construction Type: VB
Expiration Date: 5/15/2022
Code Edition: 2015 No. Stories: 0 # of Dwelling Units: 0
Issued by: NED
Scope of Work: DISTINCTIVE DENTAL- NEW DENTAL OFFICE - P&M SEPARATE
WA State Contractor L & I #: BIGSKSN841CC City of Edmonds Business License #: 602454996-001-0001
CONTACTS
NAME TYPE
NAME
A
PHONE
EMAIL
APPLICANT
CHELSEA RODGERS
5921 SE CEDAR ST., MILWAUKIE
(503)539-3657
OBSIDIANDESIGNPDX@GMAIL.COM
OR 97222
CONTACT
OBSIDIAN DESIGN, LLC
5921 SE CEDAR ST., MILWAUKIE
(503)539-3657
obsidiandesignpdx@gmail.com
OR 97222
CONTRACTOR
BIG SKY NORTHWEST LLC
4901 NE 187TH PL, LAKE FOREST
dlong@bigskynorthwest.com
PARK WA 98155
OWNER
DERKSEN LLC
19827 15TH AVE NW,
doctoramy@comcast.net
SHORELINE WA 98177
91111111111
DESCRIPTION
7CITY.T,E�CHNOLOGY
ACCOUNT
AMOUNT
PAID PAID DATE RECEIPT #
FEE CHARGED
001.000.321.99.100.00
$40.00
$40.00
5/20/21
R12465
PER RMIT
COMMERCIAL STATE SURCHARGE
001.000.237.150
$25.00
$25.00
5/20/21
R12465
INDEPENDANT FEE CALCULATION
001.000.341.82.000.00
$260.00
$260.00
5/20/21
R12465
REVIEW
PERMIT FEE - COMMERCIAL
001.000.322.10.000.00
$2,560.00
$2,560.00
5/20/21
R12465
PLAN REVIEW FEE - COMMERCIAL
001.000.345.83.000.00
$2,176.00
$2,176.00
2/1/21
R10162
TOTALS: $5,061.00 $5,061.00
CONDITIONS
CONDITION TYPE
STATUS
NOTES
FOR
CLEAR LANDINGS
CLEAR LANDINGS
NFORMATION
Installation, use and maintenance of equipment and components shall be per
MANUFACTURER SPECS
FOR
manufacturers specifications, installation instructions, and applicable state codes.
INFORMATION
Provide manufactures installation instructions on site for Building Inspector.
Nothing in this permit approval process shall be interpreted as allowing or permitting the
maintenance of any currently existing illegal, nonconforming or unpermitted building,
FOR
structure or site condition which is outside the scope of the permit application, regardless
NONCONFORMING DISCLAIMER
INFORMATION
of whether such building, structure or condition is shown on the site plan or drawing.
Such building, structure or condition may be the subject of a separate enforcement
action.
Printed: Thursday, May 20, 2021 4:41:10 PM 1 of 2
•MMERCIAL BLDG Permit
PERMIT NU
of Edmonds
EdmondsCity
980201 1
-. •. •
Final approval on a project or final occupancy approval must be granted by the Building
FOR
OCCUPANCY
Official prior to use or occupancy of the building or structure. Check the job card for all
INFORMATION
required City inspections including final project approval and final occupancy inspections.
IMAM
COMPLETED
SEQID
INSPECTION TYPE
INSPECTOR
DATE
A-1 BUILDING PRECON
B-4 DRYWALL FASTENING
B-4 FRAMING
B-5 INSULATION ENERGY
B-7 BUILDING OTHER INSP
X-3 BUILDING FINAL"
X-0 PRE-TREATMENT FINAL
B-5 CROSS CONNECTION
Printed: Thursday, May 20, 2021 4:41:10 PM 2 of 2