BLD2020-0812+City_Application+8.6.2020_10.08.37_AMBUILDING 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.mybuildinapermit.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 #: �_ Subdivision: RP #kS-lR-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 ✓❑ 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 #: 603148143
CITY OF EDMONDS BUSINESS LICENSE #: `l'l 4 814 3
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
HOMEDDC892RO Exp Date: 01/09/2022
Office Use Orly
TYPE OF
❑ Accessory Structure/
Detached Garage
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 eyWipment, materials, labor, overhead,
and the profit for thywork indicated on this application.
Valuatio
PROPOSED ..
Basement sgft: Finished ❑ Unfinished❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sg.W'
Deck/Cover Porch/Patio:
# of N Bedrooms: # of NEW Bathrooms:
PROJECT•
vu1 / ► 54 a,,( f e► , zn/e
s•F P- aU ui I jiw�
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
Signature: Date 17- _
,0
COMMERCIALGENERAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinkler !>,y190No❑
WA STATE ENERGY CODE: If your project affe ' e building envelope,
mechanical systems, and/or lighting, must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All co ercial building permits that will require
associated plumbing, m anical, fire sprinkler, and/or fire alarm
permits are applied separately.
TI / CHANGE OF / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
BTUs Gas J Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
!
Boiler
Dryer Duct
/
Exhaust Fans
i
Fireplace
i
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 Devic(RPBA, DCDA, AVB)
Drinking Fountain
Pressure -Reduction/ Regulator Valve
Floor Drain/Sink
R rigerator Water Supply
Hose Bibs
Water Heater -Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
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)
City
Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air /'
Other:
Medical -Sur ' al Vacuum Other:
DEMOLITION
Type of structure to be demolished: One -level SFR + Outbuilding
Square footage of structure to be demolished: / J
AHERA Survey done? Y[S/ N❑
PSCAA Case #:.20-20 0 2173
/
Critical Areas Determination:
Required Conditional Waiver Waiver❑
Study
WNWOMEMEM"
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Dete ination:
Stud equired Conditional Waiver Waiver
.•
Grading: Cut cubic yard /
Fill cubic s
Cut / Fill in Critical A Yes ❑ No ❑
GENERAL • •
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.