BLD2020-1271+City_Application+11.19.2020_5.04.20_PM. j7c. 1 89v
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.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinapermit.com
JOB SITE IN (Where the work is taking place)
Job site Address: 428 3rd Avenue North
Parcel: 270324-002-070-00
Lot /U n it/Su ite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Michael Field
Mailing Address: 428 3rd Avenue North
city/state/zip: Edmonds, WA 98020
Phone #: 206 877-3033
Email: MWField@gmail.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: Molly LaPatra
Mailing Address: 118 N. Argyle Place
Seatile WA 98103
City/State/Zip:
Phone #: 206 618-5206
E-mail: IapatraCLDme.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
CA Adams
110 ana reet
Mailing Address-
City/State/Zip: Seattle,
2
Phone #: 206498-2480
E-mail: c@caadams.com
STATE UBI #: 603035668
CITY OF EDMONDS BUSINESS LICENSE #: applied for
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
CADAMAL888K9 5/29/2022
Office Use Only
TYPE OF .-
Accessory Structure)
Detached Garage
Details _
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: $55,000
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finishe Unfinished
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT
I
t
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.
Molly LaPatra
Print Name:
I 11 /19/20
Signature: Date
GENERAL• 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 •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler/VAV
Boiler
Dryer Duct
Exhaust Fans TBD 3
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE • • or piped)
Qty Qty
Clothes Washer Tub/Showers 2
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
I
Sinks 4 Other:
Toilets 1 Other:
BTUs Qty BTUs Qty
A/C Unit Outdoor BBQ / Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ insert I I ) Other:
Furnace I i i Other:
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medical -Surgical Vacuum Other:
Type of structure to be demolished: Interior finishes Of main a
Square footage of structure to be demolished:
AHERA Survey done? y0 / PSCAA Case #:
Critical Areas Determination:
Study Required❑ Conditional Waiver[] Waiver❑
Fill in Place Fill Material:
Removal Size ofTnk (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area
vo
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.