BLD2020-0751+City_Application+7.21.2020_3.44.16_PM/rl7)t)
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmonsfswg.00y.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinrtaermit.cram
I JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 202 Main St.
Parcel: 00454800101300
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Mary Olsen
Mailing Address: 221 2nd Ave.
City/State/Zip: Edmonds, WA 98020
Phone #: Unknown
Email; Unknown
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? r-1Y e s Fv—(]No
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: Carol A. Reilmann
Mailing Address: 11875 Silverdalw Way NW #104
City/State/zip: Silverdale, WA 98383
Phone #: (360) 692-8840
E-mail: carol@silverdaleplumbng.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Silverdale Plumbing & Heating,
Mailing Address: PO BOX 963
City/State/Zip: Silverdale, WA 98383
Phone #: (360) 692-8840
E-mail: dennis@silverdaleplumbing,.com
STATE UBI #: 600 322 296
CITY OF EDMONDS BUSINESS LICENSE M SII-VEI*220N U
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
035,221-00 08/31 /2020
Office Use Only
TYPE OF PERMIT (Provide Delails an Page 2)
❑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:
Basement sgft: Finished❑ Unfinished❑
Ist Floor, sq ft:
11,135
2nd Floor, so ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: I # of NEW Bathrooms:
Plumbaig under
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: Carol A. Reilmann
Signature: l__&:� LDS', L iIJ-t ,WA Date 7/21/2020
GENERALDATA.,.
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
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
1
Sinks
Other:
Toilets
Other:
BTUs Qty BTUs Qty
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert Other:
Furnace I I I Other:
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum
Other:
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ N[j 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 ❑
APPLICATIONS: Applications are valid for a maximum of I 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,