BLD2020-0812_City_Application_8.6.2020_10.08.37_AM`��c•. 18ct"
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswo.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mVbuildinggermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 7115 174th ST SW, Edm 98026
Parcel: 00513100013804
Lot /Unit/Suite #: 3 Subdivision: SP #S-R-79
BUSINESS OR PROPERTY OWNER:
Name: Home Development Company, Inc.
Mailing Address: 502 92nd ST SE
City/State/Zip: Everett, WA 98208
Phone #: 425-582-1016
Email: dave.nolan214@gmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes Fv—] 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: Home Development Co, Inc.
Mailing Address: 502 92nd ST SE
City/State/Zip: Everett, WA 98208
Phone #: 425-582-1016
E-mail: dave.nolan214@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Home Development Co, Inc.
Mailing Address: 502 92nd ST SE
City/State/Zip: Everett, WA 98208
Phone #: 425-582-1016
E-mail: dave.nolan214@gmail.com
STATE UBI M 603148143
CITY OF EDMONDS BUSINESS LICENSE #: `N� 5 I C! 14 3
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
HOMEDDC892RO Exp Date: 01/09/2022
Office Use Only
TYPE OF PERMIT (Provide
❑Accessory Structure/
Detached Garage
Details on Page 2)
Addition
❑
❑✓ Demolition
Mechanical
DNew 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 epwi� ent, materials, labor, overhead,
i and the profit for th ork indicated on this application.
ValuatiPROPOSED
NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished❑ Unfinished
1st Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq;W.'
i
Deck/Cover Porch/Patio:
# of N Bedrooms: # of NEW Bathrooms:
WO / ', SIB a, re-, zye et s-k e
J
S'F IR and aut 4f 1 Ji-g
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 . avid E Nolan, VP
% l7�- 2oZo
Signature: �— Date
COMMERCIALGENERAL 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 Iighting,yoU must complete the
appropriate WSEC forms. '
DEFERRED SUBMITTALS: All comfi ercial building permits that will require
associated plumbing, me h�anical, fire sprinkler, and/or fire alarm
permits are applied fof separately.
i
TI / CHANGE OF/VSE / 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 nit (Provide eleva-
tions if Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE 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 f '
Other:
Toilets
Other:
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:
MEDICAL•
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: One -level SFR + Outbuilding
Square footage of structure to be demolished:
AHERA Survey done? Y®/ N❑
PSCAA Case if:2-02-0 0 29 73
Critical Areas Determination:
Conditional Waiver❑ Waiver❑
6StudyRequired0
0
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Dete ination:
Stud equired Conditional Waiver Waiver
.•
Grading: Cut cubic yards-" l
i
Fill cubic Y�r$s
Cut / Fill in Critical A a: 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.