BLD2021-1197+Application+8.27.2021_11.01.26_AM+2380273"c. 1 67
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mvbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 21410 96th Ave W
Parcel: 00496500001100
Lot /Unit/Suite #: 11 Subdivision: Leanne Lane
BUSINESS OR PROPERTY OWNER:
Name: Chris Sellstone and Linda Bliss
Mailing Address: 21410 96th Ave W
City/State/Zip: Edmonds, WA 98020
Phone #:
Email: csellstone@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: Nina Franey I EDGE
Mailing Address: 1845 NW 195th St
City/State/Zip: Shoreline, WA 98177
Phone #: 206.940.5627
E-mail: nina@edgedesignbuild.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: EDGE design & build LLC
same as above
Mailing Address:
City/State/Zip:
Phone #:
E-mail: suzanne@edgedesignbuild.com
STATE UBI #: 602139085
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
EDGEDBL990NB
Office Use Only
TYPE OF
Details
Accessory Structure/
Addition
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
R1 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 equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: $250,000
PROPOSED..
Basement sgft: Finished❑ Unfinished ❑
1st Floor, sq ft: N/A: NO N
W SF, TYP
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
Remodel to existing single family
home, no change to footprint. Work to
include LlIdIlgeb to kitLhelll
,, I ,,� openings,
hroorn
and
and�6."asernenCba
rem! el,nel./ fi nn o q h p q r,vr,
remodel,
TrQTtaa
wnrk_ Work alto includes replaremPnt
of existing gas furnace with new
heatpump and new on demand WH
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.
N
Print Name: Nina Franey
8/27/21
Signature: Date
*MECH/PLUMBING COUNTS HAVE BEEN IDENTIFIED BUT FINAL APPLIANCES HAVE NOT YET BEEN SELECTED*
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
elec
1
Exhaust Fans
Fireplace
tbd
gas
1
Furnace
Heat Pump Unit
tbd
elec
1
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
1
Tub/ Showers
1
Dishwasher
1
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
1
Hydronic Heat
Water Service Line
Sinks
1
Other:
Toilets
1
Other:
CONNECTION. d or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
tbd
1
Boiler
Stove/Range/Oven
Dryer
Water Heater
tbd
1
Fireplace/ Insert
tbd
1 Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
(New,
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: n/a
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ N❑
FPSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver❑
Fill in Place ❑ Fill Material: n/a
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
Grading: Cut 1 cubic yards
Fill 1 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.