City of Edmonds Building Permit Application 4.20.2020/)C. I SL)"
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.aov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, large Additions, ADU's, New Commercial, and Major Tenant
Improvement application submittals. If plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please call425-771-0120 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION:: (Whey the work i taking place)
Job Site Address: /Z 1 1 � v W/
Parcel: 2 7o 1 / 60030 �?
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER: J , Y / /� % I
Name: be&45 &k /l7d�i[iYJ V e l �`Q,I6a(=
Mailing Address: 8 1 a go ./� P! ,S W
City/State/Zip: 46w 'V4 `VQ�
Phone #: ? 5' & l - /q_
Email: Q/ j2
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes ;d 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: - J
Name of Applicant: DCJbOlaJt-B/der' �,11�f
Mailing Address:
City/State/Zip: (�lClrCstJ W q Zip
Phone #: 4-Z5-361 ' 4,
E-mail: Ja1CJ OkA yG-itoo. C �LYt
GENERAL CONTRACTOR: (If different, fromapplicant) �1
General Contractor: L4_ Aell(W& f _6A5l•,` LkCfi'0 )
Mailing Address: 6�.6. �QB/ r!dd 64
City/State/Zip: 6go Ults �' i L ezo
Phone #: -70— -I G
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
9 2DZ.0
Office Use Only
TYPE OF
❑ Accessory Structure/ ❑ Addition
Detached Garage
emolition
❑ 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:
PROPOSED NEW SQUARE
Basement sq ft:
FOOTAGE FOR THIS APPLICATION
Finished ❑ Unfinished
1st Floor, sq ft:
2nd Floor, sq ft:
YJ
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
(f.
Other sq ft: W64t,
PROJECT
2—r
DESCRIPTION
-mill
1&4LW!�
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: bg:hO d h �Il'cGtQ/' l i f Vel/%P.cl,
Signature: 61mh4 Date T ZQ�
GENERAL• DATA
Occupancy Group(s): F- Occupant Load(s):
/Now❑
Type(s) of Construction: W�
,,/
Fire Sprinklers: Yes I�
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
1
�(
Air Handler/VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Dx
Furnace
12n W
1 u✓
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
'
Tub/ Showers
%
!/-r
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
'
Refrigerator Water Supply
Hose Bibs
%
f•/
Water Heater - Tankless? Y or�
I
Hydronic Heat
Water Service Line
Sinks
(^
Y
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
Zp
Other:
Furnace J V01 Z Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated or .. .
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: �n
AHERA Survey done- Y 1 N
PSCAA Case #:
W
Critical Areas Determination: (_
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material:
Removal
Size of Tank (Gallons)
Critical Areas Determination: Uftp iekd
Study Required ❑ Conditional Waiver ❑ Waiver ❑
.D
Grading: Cut Zoo cubic yards
Z160
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.
W
FILCO COMPANY INC.
P.O. Box 31228 • Seattle, WA 98103 • Ph: (206) 547-8347 • Fax: (2061 548-9352
e-mail: info@FilcoEnviro.com • www.FilcoEnviro.com • Lic# FILCOCIOBORU
LETTER OF CERTI F ICATION
May 2, 2005
Cliff Cameron
8912 192"1 Street SW
Edmonds, WA 98026
RE: Residential Underground Heating Oil Tank at 8912 192" d Street SW
Edmonds, Washington
This is to certify that Filco Company Inc. has pumped, triple rinsed, and
permanently capped below grade and left empty, one 300 gallon underground
residential heating oil tank from the above named property. All work was done
and meets local and state fire code permit conditions for abandonment in place
with no filling.
r-�-PL J- ---.n
'S
Phil Suetens
Filco Co., Inc.
Abestos Removal
Of
FPuget Sound, LLC
CERTIFICATE OF COMPLETION OF ABATEMENT
02-10-2020
Owner: Deborah Binder
Project: 8912 192"d Street SW Edmonds WA98026
This letter is to certify that all asbestos containing materials were removed and disposed
of from the property with the address above. We removed all the asbestos containing
vinyl and popcorn ceilings from the home.
All work was performed in strict compliance with all federal, state and local regulations.
If you have any questions, please do not hesitate to give us a call.
Sincerely,
Tina Page
Asbestos Removal of Puget Sound LLC
asbestosremovalps@gmail.com
Everett WA 98204
206-786-6667
2/8/2020 Approved Transaction
psclean air.org
Puget Sound . Agency
Single -Family Notification Case #: 202000648
This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available
for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $25.00
Credit Card Transaction # APOA64843DE2
Transaction Date 02/08/20
Owner's Name Deborah Binder Phone (425) 361-3942
Project Street Address 8912 192nd Street SW
City Edmonds Zip 98026
Contact Person Tina Page Phone (206) 786-6667
Mailing Address
This project includes asbestos removal.
Project Size linear feet / 1200 square feet
Project Start Date 02/08/20 Completion Date 02/03/21
Asbestos will be removed by a licensed asbestos abatement contractor
I certify that:
(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
Create Another Notification
If you have questions, contact us at asbestos@pscleanair.org or 206.689,4058.
https://secure.pscleanair.org/Asbestos/Approved.aspx 1 /1
Critical Area Determination (CRA2O190191) 8912 192nd ST SW, Edmonds ct�tj
- cda/ J
Edmonds Development Services Admin (devserv.admin@edmondswa.gov)
jaideborah@yahoo.com
Wednesday, December 18, 2019, 11:54 AM PST C(-J
Dear Applicant/Owner,
Attached please find the completed site determination for the Critical Areas Checklist you submitted to the City of Edmonds Planning Division. Please note that
this determination is a site -specific determination and not a project -specific determination.
Please examine this site determination for additional requirements. You may need to submit additional information such as an Environmental Checklist or
Critical Areas Study which is specified in the documents you have received.
If you have any questions regarding this site determination, please call the Development Services Department. 425.771,0220, and ask for the planner (Michele
Szafran, ext. 1778j who reviewed your submittal.
Thank you,
Debbie Rothfus
Administrative Assistant, Development Services
Development Services
City of Edmonds
121 5th Ave North, 2nd Floor
Edmonds, WA 98020
(425) 771-0220
Development Services Hours:
Monday, Tuesday, Thursday & Friday: 8:OOam-4:30pm
Wednesday's Walk-in (counter) hours: 8:30am-noon
CRA20190191.pdf
. .: Ciai
#P2o
Critical Areas File #:
i L� Initial Determination - $100
❑ Subsequent D term1)ination - $50
Date Received:
Date Mailed to Applicant:
The purpose of this checklist is to enable City staff to
determine whether any critical areas and/or buffers are
located on or adjacent to the subject property. Critical
areas, such as wetlands, streams and steep slopes, are
ecologically sensitive or hazardous areas that are
regulated to protect their functions and values. The City's
critical area regulations are contained within Edmonds
Community Development Code (ECDC) Chapters 23.40
through 23.90.
Property Owner's Authorization
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
www.edmondswa.gov
A property owner, or an authorized representative, must
fill out the checklist, sign and date it, and submit it to the
City. Staff will review the checklist, conduct a site visit,
and make a determination of whether there are critical
areas and/or critical area buffers on or near the site. If a
"Critical Area Present" determination is issued, a report
addressing the applicable critical area requirements of
ECDC Chapters 23.40 through 23.90 may be required
depending on the scope of the proposed activity.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject
property for the purposes of inspection attendant to this application. The undersigned owner, and his/her/its heirs, and
assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of
Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction
based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its
agents or employees. \
SIGNATURE OF OWNER v ` u DATE
i �—
Owner:
�ati`c�Gt A
Name
Street Address p
City State Zip
Telephone: 'u-) a
Email address: , Clyel-1 i0c) C'T)V-\
Applicant/Agent:
Name
Street Address
City State p Zip
Telephone: g,-Z 5
Email Address: r r cr(!'c�
Revised on 114117 P20 - Critical Areas Checklist Page I of 2
,-a City of Edmonds
Critical Area Map