BLD2021-0235+application Other+3.18.2021_11.50.57_AM+2099607RECEIVED
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Mar 30 202BUILDING PERMIT
NDS
DEVELOPMENT ITY OF OERVCES APPLICATION
DEPARTMENT Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771,0220
For handouts; submittal requirements go for www.edmondswo.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 Addrep, -rh Vr W.EDMOND
Parcel: 0048880020-041,Q
Lot /Unit/Suite M 9 Subdivision: fi91722-S mat
BUSINESS OR PROPERTY OWNER:
Name: PHUONG VO-THANH TRANG
Mailing Address: 14534 27th AVE. NE.
City/state/zip: SHORELINE, WA 98155
Phone #: 206-227-1031
Email: johntrang20l2@yahoo.com
OWNER INSTALLATION: *if yes, read and sign*
Will work be performed by the property owner? ZYes❑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
1827.090. �T
Owner Signature: Vo
_ h4,t z�iolZ I
APPLICANT / CONTACT INFORMATION:
Name of Applicant: PHUONG VO - THANH TRANG
MailingAddress: 14534 27th aye. NE.
City/State/zip: SHORELINE, WA 98155
Phone #. 425-344-0688
E-mail'. johntrang20l2@yahoo.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: T & D GENERAL CONT.
Mailing Address:14534 27th AVE NE.
City/state/zip: SHORELINE, WA 98155
Phone #: 206-227-1031
E-mail: johntrang20l2@yahoo.com
STATE UBI #: 602-836-204
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & f ##: (CCB) & EXPIRATION DATE:
OIfiC:e Ilse Chi y
Permit i
TYPE OF PERMIT (Provida Ra#nik — Prins
Accessory Structure/
Detached Garage
Addition
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
Remodel
New Commercial/Mixed Use
Re -Roof
EJSigns
❑ Tank
ElTenant 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 indicafed on this application.
Valuation;
PROPOSED NEW SQUARE FOOTAGE
Basement sq ft Finished
FOR THIS APPLICATION
Unfinished
1st Fbor, sq ft:
1 C3 1 F
7
g 2nd Floor, sft:
�do
Garage/Carport:, sq ft
L
Deck/Covered porch/Patio:
•-lr
# of NEW Bedrooms: f # of NEW Bathrooms:
I certify that the information I have provided on this form/application is true,
correct and complete, and that I am the propenyowner orduly authorized
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: PHUONG VO
GENERAL COMMERCIAL DATA
Occupancy Group(s): V5 Occupant Load(s): SFH
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
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas / Elec / Other QtY
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial 01dg)
Other:
PLUMBING FIXTURE COUNTS (New, Relocated or re piped)
City Qty
Clothes Washer Tub/Showers `Z
Dishwasher Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain Pressure Reduction/ Regulator Valve
Floor Drain/Sink Refrigerator Water Supply
Hose Bibs Water Heater -Tankless? YorN
Hydronic Heat Water Service Line
Sinks 3 Other:
Toilets 3 other:
BTUs City BTUs City
A/C Unit Outdoor BBQ/ Fire
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/Insert Other:
Furnace 1 Other:
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical -Surgical Vacuum
Other:
Type of structure to be demolished: NO
Square footage of structure to be demolished: NIA
AHERA Survey done? Y❑/No PSCAA Case If;
Critical Areas Determination:
Study Required El Conditional Waiver [I Waiver ✓❑
Fill in Place ❑ Fill Material:
Removal❑ Size of Tank (Gallons) N/A
Critical Areas Determination:
Study Required Conditional Waiver Waiver
Grading: Cut 80 cubic yards
FIII U cubic yards
Cut / FIII in Critical Area: Yes
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.