BLD2020-1395+City_Application+12.17.2020_6.35.33_PM+1954040BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinayermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 7726 202nd place sw
Parcel: 00512700001200
Lot /Unit/Suite #: 17 Subdivision: Meath -nark
BUSINESS OR PROPERTY OWNER:
Name: Mark & Debbie Smith
Mailing Address:
7726 202nd PI. SW
City/State/Zip: Edmonds WA 98026
Phone #: 253.778.3679
Email: markcsmith45@gmail.com
OWNER INSTALLATION: 'If yes, read and sign*
Will work be performed by the property owner? 7Yes ❑ 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: Mark & Debbie Smith
Mailing Address: 7726 202nd PI. SW
City/state/zip: Edmonds WA 98026
Phone #: 253.778.3679
E-mail: markcsmith45@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: t
Mailing Addre!
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Permif N:
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: $420,739
Basement sq ft:
1st Floor, sq ft: 12
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
71,ne-nF t NEmi s N WE«1G"rR� IF A tom\ �2kkgh .
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.
Prim Name: Mark Parker
Signatu Date 12/11/20
GENERAL COMMERCIAL DATA
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
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas ( Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans 5
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUMBING FIXTURE COUNTS (New, Relocated or re piped)
City City
Clothes Washer Tub/ Showers 2
Dishwasher Backfiow Device (RPSA, DCDA, AVB)
Drinking Fountain Pressure Reduction/ Regulator Valve
Floor Drain/Sink Refrigerator Water Supply
Hose Bibs 2 Water Heater - Tankless? Y or N N
Hydronic Heat Water Service Line
Sinks 4 Other:
Toilets 3 Other:
BTUs City BTUs Qty
A/C Unit Outdoor BBQ / Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert Other:
Furnace 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: 41
AHERA Survey done? Y[]/ N❑ PSCAA Case #:
Critical Areas Determination:
Study Required❑ Conditional Waiver El Waiver❑
Fill in Place ❑ Fill Material:
Removal ❑ Size of Tank (Gallons) _
Critical Areas Determination:
Study Required Conditional Waiver Waiver
Grading: Cut 0 cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
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.