BLD2020-0866+City_Application+8.18.2020_2.56.02_PMBUILDING PERMIT Office Use •
APPLICATION I Perm
Development Services
Building Division TYPE OF PERMIT (Provide Details on Page 2)
121 5th Ave N / Edmonds, WA 98020
425.771.0220
'Oe. 1 $9
For handouts, submittal requirements go to: www.edmondswa.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinanermit.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-6-79
BUSINESS OR PROPERTY OWNER:
Name: Home Development Company, Inc
Mailing Address: 502 92nd ST SE
City/State/Zip: Everett
Ph... #: 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
Phone #: 425-582-1016
E-mail: dave.nolan214@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Same as Applicant
Mailing Address:
City/State/Zip:
Phnnp #:
E-mail:
STATE UBI #:
603148143
CITY OF EDMONDS BUSINESS LICENSE #: 603148143
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
HOMEDDC892RO Exp. Date 01/09/2022
Accessory Structure/
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: $700 000.
Basement sq ft: Finished Unfinished
1st Floor, sg ft: 1437 I-
2nd Floor, sgft: 1632
Garage/Carport:, sq ft: 668
Deck/Covered Porch/Patio: 212
# of NEW Bedrooms: rj # of NEW Bathrooms: 3
PSId ce a
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 Na
r>r,\David E Nolan, VP
Sign ature:''S&J4Vy =a
08/18/2020
GENERAL COMMERCIAL DATA
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
1
Exhaust Fans
Electric
6
Fireplace
28,000
Gas
1
Furnace
76,000
Gas
1
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
1
Tub/ Showers
4
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
1
Drinking Fountain
Pressure Reduction/ Regulator Valve
1
Floor Drain/Sink
Refrigerator Water Supply
1
Hose Bibs
2
Water Heater - Tankless? Y or N
y
Hydronic Heat
Water Service Line
1
Sinks
7
Other:
Toilets
3
Other:
CONNECTION COUNTSd or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
54,000
1
Dryer
Water Heater
198,000
1
Fireplace/ Insert
28,000
1
Other:
Furnace 76,000 1 Other:
MEDICAL•
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
,D
Grading: Cut 380 cubic yards
Fill 380 cubic yards
Cut / Fill in Critical Area: Yes ❑ No R1
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.