BLD2021-0279+City_Application+2.17.2021_11.25.46_AM+2051273,+ I ti,,.,
BUILMNG PERMIT
APPLICATION
Development Services
Building Division
121 51h Ave N / kcimands. WA 96020
42.5. M -0220
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To 0gp1y for pertnfek schedule impkCnam. or check n slaws
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]QB SITE INFORMIATMN/UDCATION: IWhore the work istsklnz*6o)
Job Site Address; 508 2ND DIVE N
Parcel:
tot j nitjSuite tF: subdivislow
BUSTNESS GR PROPERTY OWNED:
Name; Keith Sillgierorl
Mailing address. 508 2ND DIVE N
City/5 tefZip; Edmonds WA, 98020
Phone #: 806-652-9779
Em-oil:
OWN JNSTALLATION I *If vusj read and sign'
Will work be performed by the property owner?Elves R]No
I awn, resitii! in, or well aside ark the completed srNM re. This
Inritalladon Is -being Made on property that I own whIch is not
Intended for sale, lease, tent, or exchange accordIRp to RC
1.a-27-090.
Owner Sigrveture,
APPLICANT / CONTACT INFORMATION:
Name of ApplIcant: Genitor Mckeever
Mailkng Address: 8801 3rd acre NW
sty st l J : Seattle WA 98117
Pharke #; 06-880-6315
!:-rr3�iir headwater$iiW@gFf1ad.Com -
GENERAL CCINTRACIFOR: IIt different from applicantI
Gtneral Contractor:
MRIi1ng Addres%'.
City+/Suterzlp;
phunr. J#:
E-mail:
STATE USI 0- 6042M256
0TYOFEDMONDS6U5I F_5s-5UCENSE#: HEADWNC921LO
WA STATE CONTRACTOR L & I #: (CCR) & EXPIRATION OATL:
HEADWNCE21 LO 6/2T22
Per-,%l rr
DAccessory 5tra�ct�refEl
atached Garage
a4ddttton
Demolition
11 Mertranical
New SIngIt! Family/Duplex
0 Plumbing
Fire $prirlkler
RamMel
��
QNew Ccmrrrereia1/MW!t1Use
Re•gciot
Sign,
Tank
Ot11oT
Tenant Irnpravj�rnent
Remodel Perm" fees are barked ore:
Im value pf ttv work perlormod, lacAx;te, ire v Irot-ded to
t3o7ysrn85j' dntltxj Ot <i6 egtilan¢nl, mpt6:as. Igt�Cf, QMt�ad.
axi Fho PTMt r.or that wcu*?rdznl0 on its : onplcatlon
Valua#ian; 7000
PROPOSED •UARE FOOTAGE FOR+
5251�merEtsqft: Fllmhed�
liar Hoc r. 54 ft:
grid Fkear, sa fr.
Garage{C ep#rt. sq rtl
oecVCavered POTch/Para'
8 of NEDN Bedrooms-
Im ■ .
It of NEW Bathrooms;
r
Hamove beaairR9 wail I arrl&te mih GI - nn;v �+pst and IOGtin
1 rmlIN Vie the Irrrormatlon I have provlMd on th{t fr,rmiappl,rarlon is sear,
court acid rnmplolr, aruf that l am the prnrwdy uwni-r ai di i ly a u rfwa rand
agtrnt of ter Pr vpOrty owner tv eobrMd a PC3r.nuj a ppticati n n to tho Lily u!
UnwrWA.
Print Names:
Signatrlre:
armor McKeever
Date
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
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
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
Other:
Toilets
Other:
COUNTSGAS/FUIEL CONNECTION d 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:
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.