applicationBUILDING 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&ov.
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 call425-771-0220 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 20020 83rd Ave. W., Edmonds 98026
Parcel: 00431200000201
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Simon J. Evans / Marne C. Evans
Mailing Address: 20020 83rd Ave. W.
City/State/Zip: Edmonds, WA 98026
Phone #: 734-846-6181
Email: sievans242@_Zmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes 1KI 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: 'SQ_E1
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Simon 1. Evans
Mailing Address: 20020 83rd Ave. W.
City/State/Zip: Edmonds, WA 98026
Phone #: 734-846-6181
E-mail: sievans242@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Ealcman Construction
Mailing Address: 9226 Roosevelt Way NE
City/State/Zip: Seattle, WA 98115
Phone #: 206-972-2275
E-mail: info@ealcmanconstruction.com
STATE UBI #: 603 465 212
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
EAKMACC851DL 3/13/2021
TYPE OF PERMIT (Provide Details on Page 2)
❑ Accessory Structure/
❑ Addition
Detached Garage
❑ Demolition
❑ Mechanical
❑ Plumbing
A New Single Family / Duplex
❑ 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 FOOTAGE FOR THIS APPLICATION
Basement sq ft: 631 Finished 09 Unfinished ❑
1st Floor, sq ft: 1168
2nd Floor, sqft: 1108
Garage/Carport:, sq ft: 764
Deck/Covered Porch/Patio: 530
Other sq ft:
PROJECT•
New construction of 4 bedroom, 3.5 bath home.
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: Simon J. Evans
Signature: 9Z Date 1/2/2020
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 City
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Electric
1
Exhaust Fans
Electric
5
Fireplace
80K
Gas
1
Furnace
Heat Pump Unit
Electric
1
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE ..
Qty Qty
Clothes Washer
1
Tub/Showers
4
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
1
Refrigerator Water Supply
1
Hose Bibs
2
Water Heater - Tankless? Yes
1
Hydronic Heat
Water Service Line
1
Sinks
6
Other:
Toilets
4
Other:
CONNECTION• .. .. .
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBC,/ Fire pit
1
Boiler
Stove/Range/Oven
60K
1
Dryer
60K
1
Water Heater
80K
1
Fireplace/ Insert
80K
1
Other:
Furnace
40K
1
Other:
MEDICAL•
Relocated .
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished: none
Square footage of structure to be demolished:
AHERA Survey done? Y / N
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
ill
Fill in Place ❑ Fill Material:
Removal ❑ Size of Tank (Gallons)
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
GRADE/ LL/EXCAVATE
Grading: Cut 50 cubic yards
Fill 0 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.