DNS-Doc #2 - Building Permit Application - City Application (MBP)L) 'i
100
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.gov.
To applyfor 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: 15722 72nd Ave W
Parcel: 00513100002501
Lot /Unit/Suite #: I at #3 Subdivision: Meadowview Estates
BUSINESS OR PROPERTY OWNER:
Name: Kevin Keck & Heather Hathaway
Mailing Address: 538 Battery St Apt #508N
City/State/Zip: Seattle WA 98121
Phone#: (775) 772-2630
Email: kevkeck@me.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner?F—]Yes P'l 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: Kyle Zerbey
Mailing Address: 6522 9th Ave NW
City/State/Zip: Seattle WA 98117
Phone#: (206) 930-5147
E-mail: kyle@studiozerbey.com
GENERAL CONTRACTOR: (if different from applicant)
General Contractor: To Be Determined
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 Only
TYPE OF PERMIT (Provide
Accessory Structure/
Detached Garage
Details on Page 2)
Addition
Demolition
Mechanical
_0
New Single Family/Duplex
Plumbing
Fire Sprinkler
Remodel
New Commercial/Mixed Use
F-1 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:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: 381 Finished 11 Unfinished Ox
1st Floor, scl ft: 1309
2nd Floor, scl ft: 2700
Garage/Carport:, scl ft: 863
Deck/Covered Porch/Patio: 1380
# of NEW Bedrooms: 3 #of NEW Bathrooms: 4
PROJECT DESCRIPTION
New Single Family Residence with attached garage.
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: Kyl P eJ.Zerbey
Signature: Date 07/02/21
GENERAL
Occupancy Group(s):
COMMERCIAL DATA
Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: YesE] No 0-
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
MECHANICAL EQUIPMENT
COUNTS (New and Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
see gas/:uel
connection counts
Air Handler /VAV
1
Boiler
see gas/:uel
for =6-boiler
connection cot
ints
Dryer Duct
Heat Pump
1
Exhaust Fans
7
Fireplace
see gas
I uel connection COL
nts
Furnace
Heat Pump Unit
Hydronic Heating
see gas/gwel
for combilboiler
connetion counts
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUMBING FIXTURE
Qty
COUNTS (New, Relocated or re piped)
Qty
Clothes Washer
1
Tub/ Showers
4
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
1
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
3
Refrigerator Water Supply
I
Hose Bibs
6
Water Heater - Tankless? Y or N
N
Hydronic Heat
1
Water Service Line
Sinks
8
Other:
Toilets
5
Other:
GAS/FUIEL CONNECTION COUNTS (New, Relocated or re piped)
BTUs Qty BTUs Qty
A/C Unit
41,200
1
Outdoor BBQ/ Fire pit
Boiler
52,200
1
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
27,000
1 Other:
Furnace
Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, 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 El Conditional Waiver El WaiverEl
Fill in Place 0 Fill Material:
Removal El
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
GRADE/FILL/EXCAVATE
Grading: Cut 150 cubic yards
760
Fill cubic yards
X
Cut / Fill in Critical Area: Yes 11 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.