BLD2020-1232+CITY APPLICATION+10.20.2020_2.37.28_PMRECEIVED
"c. 1 Z"
Nov 10 2020
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswo.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mVbuildinanermit.com
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 190 Sunset Ave S.
Parcel:
Lot /Unit/Suite #: B Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: nick Echelberger
Mailing Address:
14205 se 36th #215
City/State/Zip: Bellevue, WA 98006
Phone #: 425-990-6200
Email: betsy@paadvisors.com
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: Tim Morris Epulo Bistro
Mailing Address: PO BOX 60152
City/State/Zip: SEaftle, WA 98160
Phone #: 2068414120
E-mail: info@epulobistro.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Cort
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Fermi+#: BLD2020-1232
TYPE OF
Accessory Structure/
Detached Garage
Addition
Demolition
Mechanical
❑ New Single Family/Duplex
Plumbing
Fire Sprinkler
❑ Remodel
New Commercial/Mixed Use
Re -Roof
Signs
❑ Tank
Tenant Improvement
❑ other
I Remodel Permit tees 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: $3000.00
PROPOSED NEW SQUAREFOOTAGE •' THIS APPLICATION
Basement sq ft: Finished Unfinished❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
850 square feet
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT
To histall a teipt crvm the deck at the iestauranton the existing patio
I certify that the information I have provided on this farm/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: tim morrls
Signature: Date 10/20/20
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: Yes ElNoD
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
MECHANICAL• • Relocated)
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:
PLUMBING ' • Relocated or • •-•
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:
GAS/FUEL CONNECTION COUNTS �New, Relocated 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:
MEDICAL A . • VACUUM COUNTS
(New, 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? YQ/ NQ
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver[]
A
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 1:1 No
GENERALPROVISIONS
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.