BLD2021-1362+Supplementals+10.4.2021_4.23.54_PM+2443875f
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Jurisdiction: Edmonds
Project Name: Tollefson ADU Building Permit
Application ID: 1029506
Supplemental Name: Plumbing Fixtures - Residential Building Permits
Enter the # of plumbing fixtures being
- installed, altered, repaired, added, or relocated
Water Heater
- Specify GAS or ELECTRIC
- QTY #
New plumbing fixture on 1 trap or set of fixtures on 1 trap
- Includes sinks, toilets, tubs, showers, etc.
- QTY #
5
Re -pipe
- Drain, vent, or water piping for each fixture served
- QTY #
Drain's w/in footprint of building
- Rainwater systems, roof deck drains, etc.
- QTY #
Water service line
- Replacement or repair
- QTY #
Water service line
- New
- QTY #
Water treating equipment (water softener)
- QTY #
Backflow protective device
- 2" and smaller
- QTY #
Backflow protective device
- Over 2"
- QTY
Graywater system or reclaimed water system
- In addition to fixtures
- QTY #
Non -grease waste pre-treatment interceptor
- Oil/water separator
- QTY
Medical gas piping system
- QTY #
Grease trap - HGI inside building
- QTY #
Gravity grease interceptor - GGI
- QTY #
Supplemental Name: Mechanical Equipment - Residential Building Permits
Enter the # of mechanical equipment units being
- installed, altered, repaired, added or relocated
Furnace
- Forced -air or gravity -type, includes ducts and appliance vents
- QTY #
Air handler
- Includes ducts (Diffusers, blowers, etc.)
- Up to and including 10,000 cfm (4719 L/s)
- QTY #
Air handler
- Includes ducts (Diffusers, blowers, etc.)
- Over 10,000 cfm (4719 Us)
- QTY #
Gas Heater
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Jurisdiction: Edmonds
Project Name: Tollefson ADU Building Permit
Application ID: 1029506
- Suspended, recessed wall, or floor -mounted units
- QTY #
Hydronic Heating System
- QTY #
Appliance Vent
- Type B, BIN, L gas vent, etc.
- QTY #
Incinerator
- QTY #
Ventilation and Exhaust
- Fans connected to single duct (bath, laundry, kitchen exhaust)
or each system which is not a portion of any heating or air-conditioning system
- QTY #
Hood
- Type 1, Type 2 or Fume Hood including ducts
- QTY # and Type
Gas Piping / # of Outlets
- New or relocated
- QTY #
Boiler or Compressor
- Up to and including 50 HP (176 KM
- QTY #
Boiler or Compressor
- Over 50 HP (176 KVV)
- QTY #
Air Conditioner, Heat Pump, or Absorption System
- Up to and including 1,750,000 Btu/h (512.9 kM
- QTY #
Air Conditioner, Heat Pump, or Absorption System
- Over 1,750,000 Btu/h (512.9 kVV)
- QTY #
Roof Mounted HVAC Units are:
Each appliance or piece of equipment regulated by the IMC for which no other item is listed
- Fire dampers, ductless mini -split systems, etc.
- QTY # and Equipment Item
2
Supplemental Name: Authorization and Acknowledgment - Building
Please select who will be performing the construction work on this project.
Work to be done by a licensed contractor, not yet selected. Name, State Contractor License Number, and City Business License Number will
be submitted prior to permit issuance.
All provisions of laws and ordinances governing this type of work will be complied with. I certify under penalty of perjury that the
information provided on this application is true and correct and, further that I am authorized by the owner of the above premises
to perform the work for which the permit application is made. I further agree to hold harmless the City of Edmonds as to any
claim (including costs, expenses, and attorney's fees incurred in investigation and defense of such claim), which may be made by
any person, including the undersigned, and filed against the City of Edmonds, but only where such claim arises out of the reliance
of the City, including its officers and employees, upon the accuracy of the information supplied to the City as part of this
application.
I hereby authorize the City representatives to inspect my property Monday -Friday between the hours of 8:00 a.m. and 5:00 p.m.
during this permit application process for verifying site conditions.
I certify, under the penalty of perjury under the laws of the State of Washington, that the information and exhibits herewith
submitted are true and correct to the best of my knowledge and that I am authorized to file this application on behalf of the
owner of the subject property.
Yes
Electronic documents submitted to the City of Edmonds for plan review and permit issuance must be provided in a format that does
not prevent the City from making code comments on the documents during review or from making the documents ready for permit
issuance. Documents submitted in any manner that prevents the City from completing the review and permit issuance process,
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Jurisdiction: Edmonds
Project Name: Tollefson ADU Building Permit
Application ID: 1029506
including but not limited to submitting documents that are locked, may result in additional review time, permitting delays, and/or
cancellation of the permit application if the problem is not resolved by the applicant in a timely manner.
Please refer to chapter 18.43 RCW, chapter 18.210 RCW, chapter 196-23 WAC and chapter 196-33 WAC for Washington State laws
governing electronic documents. An interpretative guideline from the Board of Registration for Professional Engineers and Land
Surveyors can be found at http://www.dol.wa.ciov/business/enciineersiandsurveyors/docs/eDocsinterpretiveGuideline.pd . These laws
and requirements are subject to change and the submitting parties are responsible for keeping apprised of any such changes.
Please acknowledge with your digital signature below that you understand these requirements and have verified the electronic
documents being submitted meet the City of Edmonds submittal requirements. If you have questions, contact permit processing
at onlinepermits@edmondswa.gov or 425-771-0220.
Lee A. Michaelis
The City of Edmonds makes permit applications available to the public in an effort to make its processes as transparent as
possible. By signing or initialing this document, I acknowledge that any and all information submitted as part of this application, is
public information. I further acknowledge and agree that this permit application, and any and all documents related
thereto, may be disclosed by the City of Edmonds to the public without redaction.
Enter your digital signature below.
Lee A. Michaelis
Supplemental Name: Critical Area Determination - Building
A site specific Critical Area Determination, issued by the Planning Division is required for any ground disturbing activities at the time
of application. A determination is valid for 5 years from the date in which the determination was made; after such date the city shall
require a new determination.
Does the property have a current Critical Area Determination on file with the City?
YES
If you answered YES, what is the Critical Area # (CRAXXXX-XXXX)?
If you answered NO, please apply prior to submitting for your permit. You can apply through MBP, Land Use, Critical Areas.
C RA2021-0072