BLD2020-0904+City_Application+8.24.2020_8.40.09_AM4qc. 189%)
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 78020
425.771.0220
For handouts, submittal requirements go to: www.edmondswo.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mvbuildinape►mit.com
JOB SITE IN (Where the work is taking place)
Job site Address: 510 Homeland Dr.
Parcel: 00477300000300
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Marzano, Michiah J & Anthony
Mailing Address: 510 Homeland Dr.
City/State/Zip: Edmonds
Phone #:
Email: tonymarzano78@yahoo.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner?�✓ YesF-]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: Neil Jorgensen / J3 Architects
Mailing Address: 11702 98th Ave NE, Suite 105
City/State/Zip: Kirkland, WA 98034
Phone it: 425-242-0369
E-mail: neiQ341c.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:14'."Ve
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Mailing Address: 19715LdKe s_eT Si. STD /dS S$#
City/State/Zip: N o n �y e, WA -121,
Phone #: q), 5 1 36 - -7 01
E-mail: ru$51fdn
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STATE UBI #: 6-
CITY OF EDMONDS BUSINESS LICENSE #:
Fac
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION
DATE:
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Office Use Only
TYPE OF PERMIT (Provide
Accessory Structure/
Detached Garage
Details on Page 2)
�✓ 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: $100,000
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sgft: Finished❑ Unfinished❑
1st Floor, sq ft:
196
2nd Floor, sq ft:
544
Garage/Carport:, sq ft:
380
Deck/Covered Porch/Patio:
544
It of NEW Bedrooms: 2 # of NEW Bathrooms: 1
PROJECT•
Construct 196 SF main floor addition, 544 Sf
upper floor addition, 544 Sf roof top deck, and
380 Sf garage.
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: Neil Jorgensen
i
S lgnature: Date
�- -
COMMERCIALGENERAL
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 •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Elec
1
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Elec
1
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
y
Hydronic Heat
Water Service Line
Sinks
3
Other:
Toilets
1
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:
COUNTSMEDICAL GAS, AIR VACUUM
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: Carport, shed
Square footage of structure to be demolished: 230
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.