City_Permit_Application-signedc. 189�
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.mvbuildingnermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 8717 240th St SW
Parcel: 00463301500400
Lot 4 & Hanburys Sound
Lot /Unit/Suite #: ptn Lot 5 Subdivision: View Tracts
BUSINESS OR PROPERTY OWNER:
Name: Adamant Homes, Inc.
Mailing Address:
PO Box 14790
City/State/Zip: Mill Creek, WA. 98082
Phone #: 425-422-9637
Email: loree@adamanthomes.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes Fv—(] 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: Loree Quade/Adamant Homes,
Mailing Address: PO Box 14790
City/State/Zip: Mill Creek, WA. 98082
Phone #: 425-422-9637
E-mail: loree@adamanthomes.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: K Con, LLC
Mailing Address:3324 Bickford Ave
City/State/Zip: Snohomish, WA. 98290
Phone #: 425-326-9930
E-mail: morgan@gokcon.com
STATE UBI #: 604-381-256
CITY OF EDMONDS BUSINESS LICENSE #: See attached
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
KCON*CL816B3 1/27/2023
Office Use Only
TYPE OF PERMIT (Provide
❑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:
PROPOSED.. FOR THIS APPLICATION
Basement sq ft: Finished ElUnfinished❑
1st Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
Demolition of the SF residence, detached garage and shed
for the 240th St SW Short Plat under City file #PLN2019-0052.
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: Loree Quade
Loree Quade
Signature: 202,.0729,4:T7:39-oroo" Date 7/29/2021
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 •
BTUs Gas / Elec / Other Qty
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
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
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL•
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: SF dwelling unit, detached garage & shed
Square footage of structure to be demolished: 2, 897
AHERA Survey done? Y❑✓ / N❑
(Survey)
PSCAA Case #: 202 1 03683(De
Critical Areas Determination: CRA20190158
Study Required❑ 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 ❑ 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.
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STATE OF
WASHINGTON
Limited Liability Company
K CON, LLC
K CON
3324 BICKFORD AVE
SNOHOMISH, WA 98290-9295
BUSINESS LICENSE
Issue Date: Jul 02, 2021
Unified Business ID #: 604381256
Business ID #: 001
Location: 0001
Expires: Jan 31, 2022
UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE
TAX REGISTRATION - ACTIVE
F
CITY ENDORSEMENTS:
KIRKLAND GENERAL BUSINESS - NON-RESIDENT #OBL27250 - ACTIVE
ISSAQUAH GENERAL BUSINESS - NON-RESIDENT - ACTIVE
SAMMAMISH GENERAL BUSINESS - NON-RESIDENT - ACTIVE
P
SNOHOMISH GENERAL BUSINESS EXPIRES 6/30/2022 -ACTIVE
t` EDMONDS GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2022) -ACTIVE
C
MERCER ISLAND GENERAL BUSINESS - NON-RESIDENT #190153 - ACTIVE
LYNNWOOD GENERAL BUSINESS - NON-RESIDENT #BUS002034-03-2019 - ACTIVE
`r� REDMOND GENERAL BUSINESS -NON-RESIDENT #RED17-000441 (EXPIRES 12/31/2021) -ACTIVE
F!
C LICENSING RESTRICTIONS:
Not licensed to hire minors without a Minor Work Permit.
REGISTERED TRADE NAMES:
K CON
This document lists the registrations, endorsements, and licenses authorized for the business
named above. By accepting this document, the licensee certifies the information on the application
was complete, true, and accurate to the best of his or her knowledge, and that business will be
conducted in compliance with all applicable Washington state, county, and city regulations.
Director, Department of Revenue
UBI: 604381256 001 0001
K CON, LLC
K CON
3324 BICKFORD AVE
SNOHOMISH, WA 98290-9295
UNEMPLOYMENT INSURANCE -
ACTIVE
INDUSTRIAL INSURANCE - ACTIVE
TAX REGISTRATION - ACTIVE
KIRKLAND GENERAL BUSINESS -
NON-RESIDENT #OBL27250 - ACTIVE
ISSAQUAH GENERAL BUSINESS -
NON-RESIDENT - ACTIVE
SAMMAMISH GENERAL BUSINESS -
NON-RESIDENT - ACTIVE
SNOHOMISH GENERAL BUSINESS
(EXPIRES 6/30/2022) - ACTIVE
EDMONDS GENERAL BUSINESS -
NON-RESIDENT (EXPIRES 6/30/2022)
- ACTIVE
Expires: Jan 31, 2022
Director, Department of Revenue
��6 s'caTg of
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b � 9
w � x
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0
�x'L 1889 � Y
STATE OF
WASHINGTON
Limited Liability Company
K CON, LLC
K CON
3324 BICKFORD AVE
SNOHOMISH, WA 98290-9295
BUSINESS LICENSE
This document lists the registrations, endorsements, and licenses authorized for the business
named above. By accepting this document, the licensee certifies the information on the application
was complete, true, and accurate to the best of his or her knowledge, and that business will be
conducted in compliance with all applicable Washington state, county, and city regulations.
UBI: 604381256 001 0001
K CON, LLC
K CON
3324 BICKFORD AVE
SNOHOMISH, WA 98290-9295
UNEMPLOYMENT INSURANCE -
ACTIVE
INDUSTRIAL INSURANCE - ACTIVE
TAX REGISTRATION - ACTIVE
KIRKLAND GENERAL BUSINESS -
NON-RESIDENT #OBL27250 - ACTIVE
ISSAQUAH GENERAL BUSINESS -
NON-RESIDENT - ACTIVE
SAMMAMISH GENERAL BUSINESS -
NON-RESIDENT - ACTIVE
SNOHOMISH GENERAL BUSINESS
(EXPIRES 6/30/2022) - ACTIVE
EDMONDS GENERAL BUSINESS -
NON-RESIDENT (EXPIRES 6/30/2022)
- ACTIVE
Issue Date: Jul 02, 2021
Unified Business ID #: 604381256
Business ID #: 001
Location: 0001
Expires: Jan 31, 2022
Director, Department of Revenue
Expires: Jan 31, 2022
i
Director, Department of Revenue