Building_Permit_Permit_Application_2019BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
'"C. 189" 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.aov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, Large Additions, ADU's, New Commercial, and Major Tenant
Improvement application submittals. If plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please call425-771-0220 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 23406 HUMBER LN
Parcel: 00571300101300
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: GREGORY & SUSIE WRIGHT
Mailing Address: 11010 ALGONQUIN RD
City/State/Zip
Woodway/ WA/ 98020
Phone #:
Email: GWright@ramtechnologies.com
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: Jacob Strobl
Mailing Address: 3923 N 31 st St
City/State/Zip:
Tacoma/ WA/ 98407
Phone #: 206.661.3622
E-mail: jacob@strobldesign.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Joe Myers Construction, Inc.
Mailing Address: 4418 128th PI SE
City/State/Zip: Everett/ WA/ 98208
Phone #: 425.328.7849
E-mail: joemyersconstruction@comcast.net
STATE UBI #: 602 516 739
CITY OF EDMONDS BUSINESS LICENSE #: NR•020577
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
JOEMYMC951 PP • 10/20/2021
Office Use Only
TYPE OF PERMIT (Provide Details on Page 2)
❑ Accessory Structure/ ® Addition
Detached Garage
❑ 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 sq ft: Finished ® Unfinished ❑
1st Floor, sq ft:
72 sf
2nd Floor, sq ft:
Garage/Carport:, sq ft:
483 sf
Deck/Covered Porch/Patio:
Other sq ft:
PROJECTDESCRIPTION
Convert existing carport to garage, addition of
new mudroom, remodel existing main floor &
basement per plan.
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 Nam- Jacob Strobl
Signature: Date 5/4/2020
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
Exhaust Fans
6
Fireplace
2
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE or re -piped)
Qty Qty
Clothes Washer
Tub/ Showers
4
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
Sinks
8
Other:
Toilets
4
Other:
CONNECTION COUNTS.. .. .
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
2 Other:
Furnace
1 Other:
MEDICAL•
Relocated .
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? 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.