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APPLICATIONBUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 `17c. 189" 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: www.edmondswa.gov. PLEASE NOTE: Intake appointments are required for New Single Family Residences, Large Additions, ADU's, New Commercial, and Major Tenant Improvement application submittals. if plans are prepared by a profession- al, electronic files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please call 425-771-0210 to schedule an Intake appointmentl JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 23830 Edmonds Way Parcel: 00463301000302 Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: Rnk Eastside LLC Mailing Address: 2603 78th Avenue NE City/State/Zip: Medina, WA 98039 Phone #: 425-442-7433 Email: kkorovkin@gmaii.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 Zsal aa, t, or exchange according to RCW 18.27.090. Owner Signa APPLICANT / CONTACT INFORMATION: Name of Applicant: Haynes Lund Mailing Address: 385 101st Avenue SE City/State/Zip: Bellevue, WA 98004 Phone #-, 425-643-3921 E-mail. HWLArch@comcast.net GENERAL CONTRACTOR: (If different from applicant) General Contractor: LZG Construction LLC Mailing Address: 2042 S 312th Street City/State/Zip: Federal Way, WA 98003 Phone #: 253-740-3303 E-mail: izgconstruction@gmail.com STATE UBI #: 603-337-725 CITY OF EDMONDS BUSINESS LICENSE #: applied for WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: LZGCOCL873PP F Permit #: � j''� r7 %) _91 TYPE CIF PERMIT (Provide U Accessory Structure/ Detached Garage Details on ..- ❑ Addition ❑ Demolition ❑ Mechanical ❑ New Single Family / Duplex 0 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: $799,000 PROPOSEi) NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished ❑ Unfinished 11 1st Floor, sq ft: 2486 SF end Floor, sqft: 2421 SF Garage/Carport:, sq ft: Deck/Covered Porch/Patio: 727 SF other sq ft: 3rd Floor 2421 SF PROJECT• Construct a new 3-story apartment building containing 10-units and its associated parking and c1ccess drives. 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: Haynes Lund Signature: /��1 Date 7/26/2019 GENERAL COMMERCIAL DATA Occupancy Group(s): R-2 Occupant Load(s): 47 Type(s) of Construction: V-S Fire Sprinklers: Yes 0 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 Electric 10 Exhaust Fans Fireplace Furnace Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- lions if a Commercial Bldg) Other: RelocatedPLUMBING FIXTURE COUNTS (New, . .. Qty Qty Clothes Washer 10 Tub/ Showers 13 Dishwasher zoi 10 Backflow Device (RPBA, DCDA, AVB) 1 Drinking Fountain Pressure Reduction/ Regulator Valve 1 Floor Drain/Sink Refrigerator Water Supply 10 Hose Bibs Water Heater -Tankless?--Y-er N 10 Hydronic Heat Water Service Line 1 Sinks 23 Other: 1 Toilets 13 Other: GAS/FUEL CONNECTION COUNTS (New, Relocated 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: COUNTSSAS, AIR VACUUM or re -piped) City Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: ` Type of structure to be demolished: i 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 ❑ ••EXCAVATE FGrading: Cut cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ No 0 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.