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BLD2023-1271+PAPER APPLICATION 10.12.2023_8.43.48_AM+3836829> U DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION Est 1 g90 121 5" Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 2 Fax 425.771.0221 PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): 750 NORTHSTREAM LN , EDMONDS, WA 98020-2637 Parcel #: 00532500001200 Subdivision/Lot #: Project Valuation: $ 26,182.00 APPLICANT: Olga Ticot Phone: 206-698-3977 Fax: Address (Street, City, State, Zip): 18915 16th Ave S, Seatac WA 98188 E-Mail Address: permits@gomatvey.com PROPERTY OWNER: Damien Kovacic Phone: 206-735-0659 Fax: Address (Street, City, State, Zip): 750 NORTHSTREAM LN , EDMONDS, WA 98020-2637 E-Mail Address: LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: CONTRACTOR:* Matvey Foundation Repair Phone: 206-698-3977 Fax: Address (Street, City, State, Zip): E-Mail Address: *Contractor must have a valid City of Edmonds business license prior to doing work in the City. Contact the City Clerk's Office at 425.775.2525 WA State License #/Exp. Date: MATVEFR837K5 / Nov, 2023 City Business License #/Exp. Date: DETAIL THE SCOPE OF WORK: Underpinning existing foundation for additional stabilization. No change in footprint. PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement: sq. ft. Select Basement Type: Finished Unfinished 1st Floor: sq. ft. Garage/Carport: sq. ft. 2nd Floor: sq. ft. Deck/Cvrd Porch/Patio: sq. ft. Bedrooms # Full-3/4 Bath # Half -Bath # Other: sq. ft. Fire Sprinklers: Yes ❑ No ❑ Retaining Wall: Yes ❑ No ❑ Grading: Cut cu. yds. Fill cu.yds. Cut/Fill in Critical Area: Yes ❑ No ❑ I declare under penalty of perjury laws 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: Olga Ticot Owner ❑ Agent/Other © (specify): contractor Signature. 06�± Date: 10/12/2023 FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014 OF EDV O v DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION FORM A Fsr 1 ggo 121 5" Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 Q Fax 425.771.0221 Equipment Type MECHANICAL Appliance/Equipment Information (new and relocated) Total # Furnace Gas #Elec #_Other: # BTUs: <100k >100k Location(s) Air Handler / VAV Gas # Elec #_Other: # CFM: <10k >10k Location(s) (circle selected) AC / Compressor / Boiler / Heat Pump / Gas # Elec #_Other: # BTUs: <100k, 100k-500k, 500k-1Mil Roof Top Unit HP: <3, 3-15, 15-30 Location(s) (circle selected) Hydronic Heating Gas #Elec #In -Floor _Wall Radiant_ Boiler BTUs: Location Exhaust Fans (single Bath # Kitchen # Laundry # Other: # duct) Fireplace Gas #Elec # Other: # Location(s) Dryer Duct FUEL GAS Appliance Type Appliance/Equipment Information (new and relocated) Total # AC Unit BTUs: Location(s): Furnace BTUs: Location(s): Water Heater BTUs: Location(s): Boiler BTUs: Location(s): Other: BTUs: Location(s): Fireplace/Insert BTUs: Location(s): Stove/Range/Oven Dryer Outdoor BBQ TOTAL OUTLETS PLUMBING FIXTURE COUNT Fixture Type (new and relocated) Total # Fixture Type (new and relocated) Total # Water Closet (Toilet) Pressure Reduction Valve/Pressure Regulator Sink (kitchen, laundry, lavatory, bar, eye wash, etc.) Water Service Line Tub/Shower Drinking Fountain Dishwasher Clothes Washer Hose Bib Backflow Prevention Device (e.g. RSPA, ncnA, Avs) Water Heater Tankless? Yes No Hydronic Heat in: Floor Wall Floor Drain/Floor Sink Other: Refrigerator water supply (for water/ice dispenser) Other: FORM A 1-Muilding New Folder 2010\DONE & x-ferred to L-Building-New driveAForm A2014.docx Updated: 1/17/2014 DEVELOPMENT SERVICES RESIDENTIAL BUILDING CHECKLIST 121 5`h Avenue N, Edmonds, WA 98020 Phone 425.771.0220 2 Fax 425.771.0221 City of Edmonds PROJECT ADDRESS: Plans shall be of sufficient clarity to indicate the location, nature, and extent of the work proposed, and conform to the provisions of the adopted International Codes and City Ordinances. �a ' 0 W SUBMITTAL REQUIREMENTS The number indicates the number of copies for submittal( if applicable). Check marks indicate additional submittal requirements that may apply to your project. 121 �e ,b A A Qn M f D c O c o m f� o o dP� ua :r oil O O Application Form A 1 1 1 1 1 1 1 Site Plan 3 3 3 3 3 3 3 Reduced Site Plan (I I X 14 or 8'/z x 11) 1 1 1 1 1 1 Construction Drawings 2 2 2 2 2 Structural Drawings and Calculations 2 2 2 2 2 Energy Code Compliance (shown on plans) ✓ ✓ ✓ Site Classification Worksheet (stormwater) 3 3 3 Drainage Plan/Stormwater Plan 3 3 3 Drainage Re ort or sizing information on plans 3 3 3 Grading Plan/Excavation/Fill 3 3 3 Critical Areas Determination or Checklist 1 1 1 1 1 Geotechnical Report > 14% sloe 3 3 3 3 Washington State Contractors License ✓ ✓ ✓ ✓ ✓ ✓ ✓ Contractor's City of Edmonds Business License ✓ ✓ ✓ ✓ ✓ ✓ ✓ Plan Check Fee (due upon submittal) ✓ ✓ ✓ ✓ ✓ Peer Review Fee ✓ ✓ ✓ ✓ Park Impact Fee Worksheet ✓ ✓ Fire Sprinkler plans and calculations — see footnote 3 • Handouts and Standard Details may be found on the City's website www.edmondswa.gov or can be obtained at City Hall during normal business hours. • Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the design professional. • Sidehill or steep slope construction is not considered conventional construction and soils reports are required for lots with 15% or more slope, unless determined unnecessary by the Building Official. • New one -family, two-family, and townhouses, with a fire area greater than 3,000 sq. ft., and IRC buildings containing 5 or more attached dwelling units, require automatic fire sprinkler systems under separate permit. "Fire area" typically includes interior living space plus exterior covered decks and patios, but excludes attached garages constructed with required separation from the dwelling. FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014