BLD2020-1240+City_Application+11.11.2020_2.55.05_PM100
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th 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.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 16900 Talbot Rd Edmonds 98020
Parcel: 27040700106200
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Browns Bay LLC
Mailing Address:
7586 Icicle Rd
City/State/Zip: Leavenworth, WA 98826
Phone #: 206-930-0377
Email: Abby abby@colchuckcompanies.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: Real Property Funding Group LU
Mailing Address: 7500 Roosevelt Way NE
City/State/Zip: Seattle WA 98115
Phone #: 206-930-0377
E-mail: ryker@rpare.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 601-970-098
CITY OF EDMONDS BUSINESS LICENSE #: On file W/ city
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
REALPPF855N5 & 8/25/2021
Office Use Only
TYPE OF PERMIT (Provide
Details on Page 2)
❑Accessory Structure/
Addition
❑
Detached Garage
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: 50000
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished R1
1st Floor, scl ft:
420 sq additional finished in basement
2nd Floor, scl ft:
Garage/Carport:, scl ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms:1 # of NEW Bathrooms:)
PROJECTDESCRIPTION
Interior remodel w/ no structural changes.
New plumbing fixtures in main floor
powder bathroom. Replace downdraft stove
top in Kitchen Add fill bedroom and
bathroom in basement storage room &
make the existing window egress. New
HV C mini-split/heat pump system to heat
Electrical upgrades to be dole by
electrician under permit w/ L&I.
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: Ryker Young
Signature: Date 11 /11
COMMERCIALGENERAL
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
42k
Elec
2
Boiler
Dryer Duct
Exhaust Fans
Elec
Fireplace
Furnace
Heat Pump Unit
42k
Elec
2
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
Tub/ Showers
1
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
2
Other:
Toilets
2
Other:
COUNTSGAS/FUIEL CONNECTION d 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:
COUNTSMEDICAL GAS, AIR VACUUM
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? 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
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
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.