REVIEWED BLD2020-0914+City_Application+9.2.2020_11.24.32_AMBUILDING PERMIT
APPLICATION Permit#:
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuiidinavermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 23023 74th Ave
Parcel: 00488800200403
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: John Zipper
Mailing Address:
9111 Cascade Drive
City/State/Zip: Edmonds, WA98026
Phone #: 425-478-7748
Email: Jzipper(,zippergeo.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: John Zipper
Mailing Address: 9111 Cascade Drive
City/state/zip: Edmonds, WA 98026
Phone #: 425-478-7748
E-mail: Jzipper@zippergeo.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: n.a.
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
(ProvideTYPE OF PERMIT Details
Accessory Structure/ •Addition
Detached Garage
Demolition 1:1Mechanical
New Single Family/Duplex Plumbing
Fire Sprinkler R1 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: $125,000
Basement sgft: Finished❑ Unfinished
1st Floor, sq ft: 0
2ndFloor, sgft: n,a
Garage/Carport:, sq ft: n,a,
Deck/Covered Porch/Patio: 0
#of NEW Bedrooms:0 #of NEW Bathrooms:0
PROJECT DESCRIPTION
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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: John Zipper
Signature: Date 9/2/2020
GENERAL iCOMMERCIAL DATA
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 / Eiec./ Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
1
Exhaust Fans
$
Fireplace
42,000
Propane
1
Furnace
Remove
Heat Pump Unit
42,000
Electric
1
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other.
COUNTSPLUMBING FIXTURE Relocated or re piped)
City City
Clothes Washer
Tub/Showers
2
Dishwasher
Backflow Device (RPBA, DCDA, AVS)
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
3
Other:
Toilets
2
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re pilped�m
BTUs City BTUs City
A/C Unit
Outdoor BBQ / Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
42,000
1
Other:
Furnace
Other:
GAS,
AIR VACUUM
COUNTSMEDICAL
Relocated.
piped)
Qty
City
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical -Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished: Interior Walls
Square footage of structure to be demolished: n•a•
AHERA Survey done? Y❑/ No
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
Grading: Cut 0 cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERALPROVISIONS
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.