COMMENT BLD BLD2020-0992+City_Application+10.12.2020_9.52.27_AMIoc I �9 %,
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.mybuildinapermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 7725 168th Place SW
Parcel: 00752000000400
Lot /Unit/Suite #: 4 Subdivision: Haines Pt.
BUSINESS OR PROPERTY OWNER:
Name: Rob Williams
Mailing Address: 7725 168th Place SW
City/State/Zip: Edmonds WA 98026
Phone #: 425-879-8234
Email: audiorob@outlook.com
OWNER INSTALLATION: *If yes, read and sign*
Wil I 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: Al Cohen, architect
Mailing Address: 330 Dayton St #6
city/state/zip: Edmonds WA 98020
Phone #: 425-776-7373
E-mail: alcohendesign@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:mm A1' K Loe weir
Mailing Address: 17 2,0 I'•• 7 2- � AVE W .
City/State/Zip: _E DDA-O A) t>S ?O 0 Z(p
Phone #: 2_c�% —
E-mail: L.D EbJCiQ /40AC5 @}-{aT 11_ ,Cbm
STATE UBI #: 6 0 Z — 9 76 -- 3 29
CITY OF EDMONDS BUSINESS LICENSE #: 8L-0d `1�_(-O
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Log wE�L96 ? 5 c. - 2-
Office Use Only
TYPE OF
❑ Accessory Structure/
I Detached Garage
Details
Addition
❑
Demolition
j Mechanical
New Single Family/Duplex
i
❑ Plumbing
Fire Sprinkler
❑ Remodel
New Commercial/Mixed Use
Re -Roof
Signs
ElTank
❑
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: 24,400
PROPOSED..
FOR THIS APPLICATION
Basement sq ft:
Finished ❑ Unfinished❑
I
—1
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
I
Deck/Covered Porch/Patio: 38
# of NEW Bedrooms:
# of NEW Bathrooms:
PROJECTDESCRIPTION
nd8vv-
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- Albert Cohen
Signature: _.pate 9/25/20
COMMERCIALGENERAL DATA
Occupancv 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
l 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
i
Boiler
I
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
I
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
I Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
I Water Service Line
Sinks
Other:
Toilets
Other:
CONNECTION COUNTSd or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Boiler
i
Stove/Range/Oven
'Dryer
Fireplace/ Insert
I
Water Heater
Other:
I �
�i
Furnace
Other:
i
COUNTSMEDICAL GAS, AIR VACUUM
or re piped)
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
i
j Medical - Surgical Vacuum
Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
i
AHERA Survey done? Y❑ / N❑ PSCAA Case #:
Critical Areas Determination:
*Study Required I Conditional Waiver ❑ Waiver❑
====NO
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
i
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.