BLD2020-1299+City_Application+11.28.2020_5.01.13_PMBUILDING 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.mvbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address: 542 Holly Drive
Parcel: 27032500208500
Lot /Unit/Suite #: TraCtJr—Subdivision: HnIIV nrivP Stfhc
BUSINESS OR PROPERTY OWNER:
Name: Bill & Lori Conroy
Mailing Address: 542 Holly Drive
City/State/Zip: Edmonds, WA 98020
Phone #: 206-209-5396
Email: bconroy@eaglerockwealth.com; slavincorb
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes W] 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: Doug Cole
Mailing Address: 16802 Third Ave
City/State/Zip: La Conner, WA 98257
Phone #: 360-466-2555
E-mail: doug@dougcolearchitect.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: To be Selected
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Office Use Only
TYPE OF
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: $125,000
PROPOSED..
Basement sq ft: Finished Unfinished❑
1st Floor, sq ft:
207 sf new 90 sf remodel
2nd Floor, sgft:
86 sf remodel
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
84 sf new Wood deck
# of NEW Bedrooms: 0 # of NEW Bathrooms: 0
PROJECT
See Attached F-1r0ject D'escriptoon
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:
Signature, Date •Z'U^�
GENERAL• DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes El 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 •Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
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)
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
Hydronic Heat
Water Service Line
Sinks
2
Other:
Toilets
2
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated 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:
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ N❑
PSCAA Case #:
Critical Areas Determination:
imStudy Required ❑ Conditional Waiver ❑ Waiver❑
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
..,
Grading: Cut 15 cubic yards
Fill 15 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.
transmittal
Doug Cole, Architect
16802 Third Avenue
La Conner, WA 98257
Office 360-466-2555
Project Name: Conroy Residence Addition
Edmonds, Washington
Date: November 28, 2020
To: City of Edmonds Transmitting: Project Description
121 Fifth Avenue North
Edmonds, WA 98020
CONROY RESIDENCE PROJECT DESCRIPTION
THE PROJECT CONSISTS OF A 207 SF SLAB -ON -GRADE CRAFTS ROOM ADDITION TO AN EXISTING RESIDENCE. THE
NEW ADDITION WILL BE INSULATED AND HEATED USING ELECTRIC ZONAL HEATING. ADDITIONAL SCOPE ITEMS
INCLUDE THE ADDITION OF WINDOWS FOR VENTILATION AND LIGHT BETWEEN THE NEW ADDITION AND AN
EXISTING GENERAL STORAGE ROOM, THE CONVERSION AND RECONFIGURATION OF AN EXISTING MAIN FLOOR
BATHROOM TO A MUDROOM, AND A REMODEL OF AN UPPER FLOOR BATHROOM. IF BUDGET ALLOWS, THE TWO
EXISTING ELECTRIC WATER HEATERS WILL BE REMOVED AND REPLACED WITH A HIGH EFFCIENCY GAS -FIRED HEAT
PUMP SYSTEM, AND THE PRIMARY ZONAL ELECTRIC HEAT SYSTEMS IN THE HOME WILL BE REMOVED AND
REPLACED WITH EITHER A CENTRALLY DUCTED HEAT PUMP SYSTEM, OR A SERIES OF MINI -SPLITS WITH
SUPPLEMENTAL ELECTRIC HEATING.
Doug Cole, Architect