REVIEWED BLD RESUB1 BLD2021-0524+APP W PLUMBING COUNT+6.10.2021_12.37.29_PM+2243032RES U B
°s --IVo� Jun 10 2021 BUILDING PERMIT
CITY OFEDMONDS APPLICATION
VELOPMENT SERVICES
DEPARTMENT Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
1•2,-
IS90 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: 540 Fir PI
..,..................................
Parcel: 00536000000600 Rf=ylt= UE 1
Lot /Unit/Suite #: Subdivision: BY
BUSINESS OR PROPERTY OWNER: 'CITY OF EDMON
Name: Bui, Allison M &Casey
BUILDING DEPARTMENT
X.,.,.....,....... .... ........ ..... .....
Mailing Address:
540 Fir PI
City/State/Zip: Edmonds, WA 98020
Phone #: 206-234-5611
Email: caseybui@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: Ethan Perrigoue
Mailing Address: 17191 Bothell Way NE Suite B104
City/State/Zip: Lake Forest Park, WA 98155
Phone #: 206-432-1111
E-mail: ethan@yendes.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Contractor Unknown
Mailing Address:
City/State/Zip: _
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Office Use.
Fit#: BLD2021-0524
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
I� Signs
Tank
SFI 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: 22560
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: Finisheda Unfinished ❑
1st Floor, scl ft:
1101
2nd Floor, scl ft:
1727
Garage/Carport:, scl ft:
498
Deck/Covered Porch/Patio:
232
# 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: Ethan Perrigoue
Signature: Date 06/10/21
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
3
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
Tub/ Showers
3
Dishwasher
2
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
Hydronic Heat
Water Service Line
Sinks
4
Other:
Toilets
2
Other:
COUNTSGAS/FUIEL CONNECTION d or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
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:
Square footage of structure to be demolished:
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 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.