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BLD2020-0888_City_Application_8.24.2020_2.30.21_PM'le. I S4, BUILDING PERMIT APPLICATION Permit#: 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.gov. 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 call 425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address:,,�y`�1,.! "l Parcel: -� —10 `-c ODD � q V Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: n (� ' /' Name: �\' )w \�A- o \ ',ZL+z C� 1� _ Mailing Address: } �� \C'C0LyV' S'-�,N\Jck City/State/Zip: W (�' 9 6'_ �t 4 Phone #: Email: OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? E'.6es ❑ 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: " r Mailing Address: 11 LAMA c �;.�n E _ City/State/Zip: Phone #: �Z�_�y 'Lf3�t -C u 'S E-mail: �C_ vs � � V q {'CdC)' 'S C 0'��C C� GENERAL CONTRACTOR: (If different from applicant) General Contractor: -5 WNc AS 490ir, Mailing Address: City/State/Zip: Phone #: E-mail: STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: (ProvideTYPE OF PERMIT Details on Page ❑ Accessory Structure/ ❑Addition Detached Garage ❑ Demolition ❑ Mechanical ❑ New Single Family / Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use [H'FLe-Roof ❑ Signs ❑ Tank lio'fenant 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: 140, tw, , po Basement sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: ^r-) 2nd Floor, sqft: `✓��J�� Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: —ItG. fi `�C <S no 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: <��4413 1' 4t 1J(P - WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: Signature: Date ti Zcl -Zv'c� COMMERCIALGENERAL DATA Occupancy Group(s): Occupant Load(s): Type(s) of Construction: Fire Sprinklers- Yes ❑ No ❑ 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 • Relocated) BTUs Gas / Elec / Other Qty A/C Unit /Compressor Air Handier/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 . .. 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 Stave/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other - MEDICAL GAS, AIR VACUUM COUNTS .. .. 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 #: 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 ❑ •.D Grading: Cut cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ 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. a � s STATE OF WASHINGTON BUSINESS LICENSING SERVICE Thank you for filing online Our processing time generally takes up to 10 business days. Some endorsements may take more time for state or city approval. You will receive your business license with approved endorsements in the mail. An updated business license will be mailed to you when additional endorsements are approved. Confirmation Number: 0-015-788-631 Filing Date and Time: 08/14/2020 10:35:17 AM Payment Method: ACH Debit/E-Check Business Entity Information Entity Type: Sole Proprietorship Name of Entity: AccountlD: 601109407-001-0003 Firm Name: TA MANNING Endorsement(s) Applied For Begin Edmonds General Business - 08/14/2020 Non -Resident Fee Type Begin BLS Processing Fee 08/14/2020 End Count Fee 08/31 /2021 1 $50.00 $50.00 End Count Fee 1 $0.00 $0.00 Grand Total: $50.00 txL0004 8/24/2020 Gilson - Google Maps o gle Maps Gilson Imagery ©2020 Google, Map data ©2020, Map data ©2020 10 ft 35ms; https://www.google.com/maps/place/Gilson/@47.792942,-122.3372401,40m/data=!3m 1I1 e3!4m 12! 1 m6!3m5! 1 sOx54901 a992d4d6a 13:Ox183cd84447d2d843!2sBoo+Han+Oriental+Market!8m2!3d47.79... 1 /6