BLD2020-0678+City_Application+7.1.2020_2.55.05_PMInc•. l Raw
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.mVbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 24109 92nd Ave W
Parcel: 00463302100506
Lot /Unit/Suite #: 3 Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Naomi Ogan
Mailing Address: 24109 92nd Ave W
City/State/Zip: Edmonds, WA 98020
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will 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: Ethan Home Repair & Remodelin,
Mailing Address: 313 Heather Rd
City/State/Zip: Everett, WA 98203
Phone #. 425-293-7913
E-mail: milt@ethanhomerepair.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Same as above
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 602727916
CITY OF EDMONDS BUSINESS LICENSE #: NR-026532
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
ETHANHR934PB Mav 31 st. 2021
TYPE OF PERMIT (Provide
Accessory Structure/
Detached Garage
Details
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: 10K
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished❑ Unfinished
1st Floor, sq ft:
0
2nd Floor, sq ft:
0
Garage/Carport:, sq ft:
128.0
Deck/Covered Porch/Patio:
0
# of NEW Bedrooms:0 # of NEW Bathrooms:0
PROJECT•
lrfik tr�� 'DIy\ �An 6 e- aC,ci c�
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: Milt
Signature: Date?
r
GENERAL• DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes❑ No21
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 • andRelocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handier /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Hea ng
Roof T;�o-rnercial
nit (Provide eleva
tions if Bldg)
Other:
COUNTSPLUMBING FIXTURE or re piped)
Qty Ctty
Clothes Washer Tub/ Showers
Dishwasher Backflow Devic PBA, DCDA, AVB)
Drinking Fountain Pressur eduction/ Regulator Valve
Floor Drain/Sink rigerator Water Supply
Hose Bibs Water Heater - Tankless? Y or N
Hydronic Heat Water Service Line
Sinks Other:
Toilets Other:
BTUs Qty /BTUs Qty
A/C Unit Outdoor 8 Fire pit
Boiler ve/Range/Oven
Dryer Water Heater
Fireplace/ I rt Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated or • •-•
Qty Qty
Carbon Dioxide Nitrous Oxide
Helium xygen
Medical Air Other:
Medi - Surgical Vacuum Other:
Type of structure to be demolished: Prefab PVC Shed
Square footage of structure to be demolished: 80
AHERA Survey done? Y[J/ NE] PSCAA Case q:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material:
Removal ❑ Size of Tank (Gallons)
Critical Areas D rmination:
udy Required Conditional Waiver Waiver
Grading: Cut cubic yards
Fill is yards
Cut / Fjf1.i ritical 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.