REVIEWED BLD BLD2020-1142+City_Application+10.22.2020_4.36.42_PMECEIVERILDING PERMIT - -•
,Oct 27 2020 APPLICATION Permit#: BLD2020-1142
CITY OF EDMONDS
)EVELOPMENT SERVICES Development Services
DEPARTMENT Building Division TYPE OF PERMIT (Provide Details on Page 2)
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.mVbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 23320 Hwy 99 Edmonds, WA 98026
Parcel: 00576700002003
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: COMMUNITY HEALTH CENTER OF SNO CO
Mailing Address: 8609 EVERGREEN WAY
City/State/Zip: EVERETT, WA 98208-2619
Phone #: 425 967-0400
Email: marlene@crowebldg.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: Berry Sign
Mailing Address: 7400 Hardeson Rd
City/State/Zip: Everett WA 98203
Phone #: 253 833-3600 ext 151
E-mail: mikel@berrysign.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 603454590
CITY OF EDMONDS BUSINESS LICENSE #: BERRYNC077CM
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
521.819-00
Accessory Structure/
Detached Garage
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: $18,800
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished Unfinished
1st Floor, sci ft:
2nd Floor, sci ft:
Garage/Carport:, sci ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
Install two illuminated ground signs and one illuminated
suspended sign.
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: Mike Lee
Signatur Date 10.22.20
COMMERCIALGENERAL DATA
Occupancy Group(s): 651 Medical & Other Occupant Load(s):
Health Services
Type(s) of Construction: Sign Install 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:
CONNECTION COUNTSd 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•
(New, 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: N/A
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
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.