BLD2020-0975_City_Application_9.21.2020_4.19.41_PM`'` ` j'''��l BUILDING PERMIT
_s APPLICATION
f.
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
�n c . 1 go 1, 425.771.0220
For handouts, submittal requirements go to: www.edmondswo.gov.
To apply for permits, schedule inspections, or check application status
go to: www.rnvbuildrrx:p rnnr._ont
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address: 202 Main Street, Edmonds
Parcel: 00454800101300
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Mary Olson
Mailing Address: 221 2nd Ave. N.
City/State/Zip: Edmonds, WA. 98020
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner?❑Yes7No
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: David Pelletier, AIA, LEED-AP
Mailing Address: 26911 98th Drive, NW, Suite B
City/State/Zip: Stanwood, WA. 98292
Phone #: 360 629 5375
E-mail: dpelletier@pelletierschaar.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Ryan General Contractors
Mailing Address: P.O. BOX 751
City/State/Zip: Woodinville, WA. 98072
Phone #: 425 488 4481
E-mail: blentz@ryangc.com
STATE UBI #: RYANGC1930PC
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
10/03/2007— 05/23/2021
Office Use Only
TYPE OF
Structure/
Detached Garage
Details on Page 2)
Addition
Demolition
Mechanical
❑ New Single Family/Duplex
Plumbing
Fire Sprinkler
New Commercial/Mixed Use
❑ Remodel
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: $250,000.00
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finisheda Unfinished
1st Floor, sq ft:
2,859
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
NEW CAFE TENANT IMPROVEMENT
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: David P ' r, AIA
Signatur Date 21 �ZO
COMMERCIALGENERAL DATA
Occupancy Group(s): A2 Occupant Load(s): 91
Type(s) of Construction: VB 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 piped)
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•
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
Grading: Cut iv /g 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.