BLD2021-1083+APPLICATION+8.4.2021_2.40.14_PM+2339561BUILDING PERMIT
APPLICATION PCrmii 4
Development Services
Building Division TYPE OF PERMIT (Provide Delcills on Page 2)
121 5th Ave N / Edmonds, WA 98020
425.771,0220
For handouts, submittal requirements go to: www.edmondswa.aov.
To appfy/or permits, schedule inspections, or check appilcation status
go to: www.mybuildirrggermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 10624 243rd PL SW
Parcel: 00564900103600
Lot/Unit/Suited: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Schell Craig & Sarah
Mailing Address: 10624 243rd PL SW
City/State/zip: Edmonds, WA 98020
Phone it: 206-226-5986
Email: craigmschell@gmail.com
OWNER INSTALLATION: *If yes, read and sign'
Will work be performed by the property owner?Yes VNo
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: Sara Wise
Mailing Address: 3252 26th Ave W
City/state/zip: Seattle / WA / 98199
phone 4: 425-922-8340
E-mail: sarawlse@me.com
GENERAL CONTRACTOR: (If differeny�tlfrom applicant)
General Contractor:: 1 /� f',t J�j, l �ji �� � �,�� -
Mailing Address: L J 2U �� I�15'"� l y l-u-V-P-'bi��e
City/State/Zip:
Phone it:
E-mail: Ukt'45��liilVl�yrNlir7iYli'��l
STATE UBI M. Z
CITY OF EDMONDS BUSINESS LICENSE fl:
WA STATE CONTRACTOR L & I q: (CCB) & EXPIRATION DATE:
IL -
Accessory Structure/
Detached Garage
Addition
✓
Demolition
Mechanical
❑ New Single Family/Duplex
Plumbing
ElFire 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 equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: 5; U DO - 0-2)
PROPOSED NEW SQUARE FOOTAGE
Basement sq ft: Finished❑ Unfinished
1st Floor, sq ft:
2nd Floor, sgft:
NA
Garage/Carport:, sq ft:
NA
Deck/Covered Porch/Patio:
#of NEW Bedrooms: NA h of NEW Bathrooms: NA
PROJECT DESCRIPTION
Small main level addition per plans
kitchen ining room.
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I certify that the information I have provided an 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 . fa S 77!!
Signatur Date - ' i6 _ uq
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
Exhaust Fans
aJ tyi kl I
Fireplace)
w�pd
Furnace
0�i
Heat Pump Unit
r1 �1
CONNECTION COUNTSRelocated
BTUs Qty
or piped)
BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
Bailer
Stove/Range/Oven
Tgo.
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
MEDICAL•
Relocated
Other:
or re piped)
Qty
city
Carbon Dloxide
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: N
AHERA Survey done? Y[]/ N❑
PSCAA Case #:
Critical Areas Determination:
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