BLD2020-1146+City_Application+10.25.2020_11.29.50_AMRECEIVED
`ne. TO`,
Oct 29 202(BUILDING PERMIT
DEVELOPMENT ITY OF DSOERDVCES APPLICATION
DEPARTMENT 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.mvbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 735 15th St SW
Parcel: 00390000001100
Lot /Unit/Suite #: 11 Subdivision: Bel Aire Div R
BUSINESS OR PROPERTY OWNER:
Name: Purser Development Services LLC
Mailing Address: 520 3rd Ave N
City/State/Zip: Edmonds, WA 98020
Phone#: 425 531-0923
Email: rob.purser@gmail.com
OWNER INSTALLATION: *It yes, read and sign*
Will work be performed by the property owner es i No
I own, reside in, or will reside in the completed s re. 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: SAME
Mailing Address:
City/State/Zip:
Phone #:
E-mail
GENERAL CONTRACTOR: (if different from applicant)
General Contractor: Purser Development Services LL
Mailing Address 520 3rd Ave N
City/State/Zip: Edmonds, WA 98020
Phone#: 425 531-0923
E-mail: rob.purser@gmail.com
STATE UBI #: 602-663-328
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
PURSEDS80OPK 10/12/22
Per it BLD2020-1146
TYPE Of
❑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 dollars of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:,om
PROPOSED•UARE FOOTAGE FORAPPLICATION
Basement sq ft: Finished Unfinished ❑
1st Floor, sq ft:
1206
Znd Floor, sq ft:
1803
Garage/Carport:, sq ft:
640
Deck/Covered Porch/Patio:
C�n
# of NEW Bedrooms:4.
PROJECTDESCRIPTION
A f-L-0 S r ��
# of NEW Bathroosns:3
L LIE —
I certify that the information have provided on this form/applicaton is true,
correct and complete, and that I am the property owner yr duly authorized
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: 6mjr _
Signature: Date i0 Z 0
GENERAL
Occupancy Group(s):
COMMERCIAL • 1
Occupant Load{sj:
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
•
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
5 ` K�
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace3��
Furnace`]
[[
(�
Heat Pump Unit
Hydronic Heating
Roof Top Unit {Provide eleva-
tions if a Commercial Bldg)
Other: n p
C,�]
�`'''
�} �
L
PLUMBING FIXTURE
COUNTS
Qty
Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPRA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
1
Hose Bibs
!�
Water Heater - Tanklessi: Ypr N
l/
i
t
Hydronic Heat
Water Service Line
Sinks 7
Other:
Toilets
3
Other:
CONNECTION COUNTS(New, Relocated or repiped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
j
1
Boiler
Stove/Range/Oven
Dryer
Water Heater
l
Fireplace/ Insert
Other:
Furnace
Other:
GAS,
COUNTSMEDICAL
AIR VACUUM
d 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? YE]/NE]
PSCAA Case d:
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
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.