City Application - signed100
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.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 835 Laurel Way, Edmonds, WA 98(
Parcel: 00455800000700
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Caleb Johns and Lara Weasea
Mailing Address: 835 Laurel Way
City/State/Zip: Edmonds, WA 98020
Phone #: 206.406.2292
Email: calebejohns@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: Blake Fisher
Mailing Address: 406 Main Street, Suite 106
City/State/Zip: Edmonds, WA 98020
Phone #: 206.852.5054
E-mail: blake@blakefisherarchitecture.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:_
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
170-8845-AAB F-7135-B D E C
Office Use Only
TYPE OF PERMIT (Provide
❑ Accessory Structure/
Detached Garage
Details on Page 2)
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 equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: 50,000
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: Finished Unfinished ❑
1st Floor, scl ft:
189 sf
2nd Floor, scl ft:
192 sf
Garage/Carport:, scl ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: 0 # of NEW Bathrooms: 0
PROJECT
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 Name: Blake Fisher, AIA
Sept. 7, 2021
Signature:&4 49-: -1 Date
EN
09,
COMMERCIALGENERAL
Occupancy Group(s): n/a Occupant Load(s): n/a
Type(s) of Construction: n/a Fire Sprinklers: Yes❑ No7
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
0
Air Handler /VAV
0
Boiler
0
Dryer Duct
0
Exhaust Fans
0
Fireplace
0
Furnace
0
Heat Pump Unit
0
Hydronic Heating
0
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
0
Other:
0
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
0
Tub/ Showers
0
Dishwasher
0
Backflow Device (RPBA, DCDA, AVB)
0
Drinking Fountain
0
Pressure Reduction/ Regulator Valve
0
Floor Drain/Sink
0
Refrigerator Water Supply
0
Hose Bibs
0
Water Heater - Tankless? Y or N
1-y
Hydronic Heat
0
Water Service Line
0
Sinks
0
Other:
0
M2 170-8845- 7-11
d
13$ WEC
COUNTSGAS/FUIEL CONNECTION d or re piped)
BTUs Qty BTUs
Qty
A/C Unit
0 Outdoor BBC,/ Fire pit
0
Boiler
0 Stove/Range/Oven
0
Dryer
0 Water Heater
1
Fireplace/ Insert
0 Other:
0
Furnace
0 Other:
0
COUNTSMEDICAL GAS, AIR VACUUM
(New, Relocated or re piped)
Qty Qty
Carbon Dioxide
0
Nitrous Oxide
0
Helium
0
Oxygen
0
Medical Air
0
Other:
0
Medical - Surgical Vacuum
0
Other:
0
DEMOLITION
Type of structure to be demolished: exterior bearing walls and roof
Square footage of structure to be demolished: 420 Sf
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
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill 4 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.
Envelope Data
Subject:
City form
Documents:
City Application.pdf
Document Hash:
10683300
Envelope ID:
ENV06229170-8845-AABF-7135-BDEC
Sender:
Blake Fisher
Sent:
09/07/2021 17:15 PM PDT
Status:
Completed
Status Date:
09/07/2021 17:33 PM PDT
Recipient(s) / Roles
Name / Role
Blake Fisher
Caleb Johns
Blake Fisher
Document Events
Address (Type
blake@blakefisherarchitecture.com Sender
calebejohns@gmail.com Signer
blake@blakefisherarchitecture.com I Signer
Name / Roles
IP Address
Date
Event
Blake Fisher blakeCblakefisherarchitecture.com
67.160.0.233
09/07/2021 17
Created
:15 PM PDT
Blake Fisher blake@blakefisherarchitecture.com
67.160.0.233
09/07/2021 17
Signed
:16 PM PDT
Caleb Johns
calebejohnsCgmail.com
50.125.89.2
09/07/2021 17
Signed
:33 PM PDT
J
09/07/2021 17
Status - Completed
:33 PM PDT
Signer Signatures
Signer Name / Roles Signature Initials
f
Blake Fisher
Caleb Johns a&" 444-01