BLD2020-0985+City_Application+9.23.2020_9.35.06_AM.,C. Its'
BUILDING PERMIT •
APPLICATION 7n.
f!
Develo m t S i
p en ery ces
Building Division
121 51h Ave N / Edmonds, WA 99020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mvbuildinapermit.con,
JOB SITE IN {Where the work is taking place)
Job Site Address: 640 Dayton St
Parcel: 00434209601300
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Mark Soleta & Courtney Prosser
Mailing Address: 640 Dayton St
City/State/Zip: Edmonds, WA 98020
Phone #: 509-218-4472
Email: msoleta@comcast.net
OWNER INSTALLATION: 'If yes, read and sign•
Will work be performed by the property owner7[:]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: Mark Soleta
Mailing Address: 640 Dayton St
city/state/zip: Edmonds, WA 98020
Phone M 509-218-4472
E-mail. msoleta@comcast.net
GENERAL CONTRACTOR: jif different from applicant)
General Contractor: Carl Clapp, C C Construction
Mailing Address 8415 192nd St SW
City/State/Zip: Edmonds, WA 98026
Phone M 206-714-9426
E-mail: carclp@comcast.net
STATE UBI #: 600-141-783
CITY OF EDMONDS BUSINESS LICENSE #: BL-006521
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
CCCON11ORF 10/12/2021
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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
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: 300,000
PROPOSED.. FOR THIS APPLICATION
Basement sq ft: Finisheda Unfinished
1st Floor, sq ft:
1,276
2nd Floor, sq ft:
1,276
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
300
# of NEW Bedrooms: # of NEW Bathrooms:2
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.
Print Name: Mark Soleta
Signature: Date
COMMERCIALGENERAL DATA
Occupancy Group(s): Occupant Loadis):
Types) of Construction: Fire Sprinklers: Yes El NoE]
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
36
electric
1
Air Handler /VAV
Boiler
Dryer Duct
0
electric
1
Exhaust Fans
15
electric
3
Fireplace
35
gas
1
Furnace
Heat Pump Unit
36
electric
9
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
City City
Clothes Washer
1
Tub/ Showers
2
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
1
Hose Bibs
Water Heater - Tankless? Y or N
y
Hydronic Heat
Water Service Line
Sinks
5
Other:
Toilets
3
Other:
CONNECTION COUNTSd or re ..-
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
35
1
Boiler
Stove/Range/Oven
60
1
Dryer
Water Heater
199
1
Fireplace/ Insert
3 5
Other:
Furnace Other:
MEDICALr
d or re piped)
Qty City
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
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
I 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.