BLD2020-1266+City_Application+11.19.2020_7.33.22_AMt'1
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 Sth 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.mybuildinapermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address: 7819 240th St Sw
Parcel: 2M4310001
Lot /Unit/Suite #: -n/a Subdivision: n ja
BUSINESS OR PROPERTY OWNER:
Name: Shawna & Gene Woodard
Mailing Address: 7819 240th St SW
City/State/zip: Edmonds, WA 98026
Phone #: 425-478-7704
Email: woodard.gene@gmaii.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑YesZ 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: Steve Hail
Mailing Address: 6121 NE 175th St
City/State/Zip: Kenmore, WA 98028
Phone #: 360-961-3638
E-mail: reviveproperties@comcast.net
GENERAL CONTRACTOR: (if different from applicant)
General Contractor: TBD
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF €DMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Permit #:
TYPE OF PERMIT (Provide
JAccessory 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: 15000
Basement sq ft: Finished ❑ Unfinished❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms -
PROJECT DESCRIPTION
ADD 28' X 12' PRE -FABRICATED ACCESSORY BUILDING
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: STEVE HALL - R VE PROPERTIES LLC
Signature:' Date 11/18/20
COMMERCIALGENERAL DATA
Occupancy Group(s). Occupant Load(s):
Types) of Construction:
Fire Sprinklers: Yes❑ Non
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you most 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 EQUIPMENT COUNTS (New and Relocated)
u, v� vaa/ [icc:/ Viner Lily
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
piped)
Qty City
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 pinecll
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ insert
Other:
Furnace Other:
MEDICAL•
Relocated or 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 #:
t,ritiCal Areas Determination:
Study Required El 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 0 No
1 APPLICATIONS: Applications are valid for a maximum of 1 year.
fj 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.