FIR2022-0029+City Application+3.16.2022_3.04.06_PM+2742180BUILDING PERMIT
APPLICATION Perm, R.
Development Services
Building Division TYPE OF PERMIT (Provide Details on Page 2)
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmandswmaov.
To apply for permits, schedule Inspections, or check application status
go to: www.mvbuildinaaermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 15722 72nd Ave W
Parcel: 00513100002501
Lot /Unit/Suite III: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: American Sprinkler Corp
Mailing Address:
2311 153rd Ave SE
city/state/zip: Snohomish Washington 98290
Phone #: 425-210-3841
Email: doug@americansprink.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: American Sprinkler Corp
Mailing Address: 2311 153rd Ave SE
City/State/Zip. Snohomish Washington 98290
Phone #: 425-210-3841
E-mail: doug@americansprink.com
GENERAL CONTRACTOR: of different from applicant)
General Contractor: E 8t H Construction
Mailing Address 5021 216th PI SE
City/state/zip: Bothell Washington 98021
Phone #: 425-486-4049
E-mail: ehconstruction1987@gmail.com
STATE UB1 #: 601-404-481
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE: CONTRACTOR L & I III: (CCB) & EXPIRATION DATE:
AMERIC087NC 2/15/24
❑Accessory
Structure/
Detached Garage
Addition
❑
Demolition
Mechanical
New Single Family/Duplex
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.
a^d the profit for the work indicated on this application.
Valuation: $20,000
PROPOSED.. FOR THIS APPLICATION
Basement sq it: Finished Unfinished
Ist Floor, sq ft:
1,690
2nd Floor, sgft-
2,700
Garage/Carport , sq ft:
863
Deck/Covered Porc i/Patio:
1,381
# of NEW Bedrooms:3
PROJECT
# of NEW Bathrooms:5
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: Doug Buehler
Signature: Date 3116/22
COMMERCIALGENERAL DATA
Occupancy Group{s): Occupant Load(s):
Type(s) of Construction- Fire Sprinklers: Yes No❑
WA STATE ENERGY CODE: If your pro,ect affects the budding 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 ECZUIPMENT COUNTS
BTUs Gas / Elec / Other City
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva
[ions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE d or re piped)
Qty City
Clothes Washer
Tub/ Showers
Dishwasher
Backfiow Device (RPSA, 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
Other -
Toilets
Other,
CONNECTIONor re piped)
BTUs Qty BTUs Qry
A/C Unit
Outdoor BBQ / Fire pit
Boiler
Stave/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other
Furnace Other:
MEDICAL•
(New, Relocated or re piped)
MY Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other.
Medical - Surgical Vacuum Other
DEMOLITION
Type of strwcture to be demolished:
Square footage of st-ucture t:i be demolished.
AHERA Survey done? YEI/ No
FpsCAA Case A
Critical Areas Determination:
Study Required❑ Conditional Waiver ❑ Waiver❑
Fill in Prace❑ Fill Mater a-:
Removal ❑ Site of Tank (Gal ons)
Critical AreRs Determination:
Study Required Conditional Waiver Waver
•r
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.