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DNS-Doc #2 - ESLHA Building Permit Application Form FCity of Edmonds DEVELOPMENT SERVICES ESLHA BUILDING PERMIT APPLICATION FORM F 121511 Avenue N, Edmonds, WA 98020 Phone 425.771.0220 PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: 15722 72nd Ave W, Edmonds WA, 98026 00513100002501 Subdivision/Lot #: Project Valuation: $ Meadowview Estates / Lot # 3 To Be Determined APPLICANT: Phone: Fax: Kyle Zerbey, Architect (206) 930-5147 Address (Street, City, State, Zip): E-Mail Address: 6522 9th Ave NW, Seattle, WA 98117 kyle@studiozerbey.com PROPERTY OWNER: Phone: Fax: Kevin Keck & Heather Hathaway (775) 772-2630 Address (Street, City, State, Zip): E-Mail Address: 538 Battery St, Apt #508N, Seattle WA 98121 kevkeck@me.com hhathaway73@gmail.com CONTRACTOR:* Phone: Fax: To Be Determined I Address (Street, City, State, Zip): Contractor License #/Exp. Date: *Contractor must have a valid City of Edmonds business license prior to doing work in the City of Edmonds Business License #/Exp. Date: 1 City. Contact the City Clerk's Office at 425.775.2525 DETAIL SCOPE OF WORK: New Single Family Residence with Attached Garage PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement: 1,690 sq. ft Select Basement Type: IX Finished I Unfinished 1't Floor: 2,700 sq. ft Garage/Carport: 863 sq ft 2,d Floor: sq. ft. Deck/Patio: 1,381 sq - ft Retaining Wall: JYes TNo YES Other: sq.ft / declare under penalty of perjury laws that the information / have provided on this formlapplication 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: Kyle Zerbey 70wner JAgent/Other (specify): Agent Signature: Date: 6/21/2021 Updated: 07/2020 Packet Item #4 DEVELOPMENT SERVICES ESLHA BUILDING CHECKLIST 121 51h Avenue N, Edmonds, WA 98020 Phone 425.771.0220 PROJECT ADDRESS: 15722 72nd Ave W, Edmonds WA, 98026 = -n Z M fD > 0 = ;a 3 M n 6) 0 lu a = CD M -n a M 0 M M fu SUBMITTAL REQUIREMENTS CL 0 3 0 0 o- Om- �w M M on 3 M 0 Check marks indicate submittal requirement (D fu CD 0 W 0 0 A VPre -Application Form V/ V/ N/ Application Form F V/ V/ V I/ n/a Critical Areas Study Document (if applicable) V/ V/ V ESLHA Map w/signature block (1 original) V/ V/ V/ V/ V/ VTopographical Map and Survey V/ V/ V/ V/ Vicinity Map V/ V/ V/ V/ V/ Site Plan V/ V/ V/ V/ I/ V Lead Design Professional Designation and V/ V/ V/ V/ Statement (1 original) Applicant/Owner Liability & Landslide V/ V/ I/ V/ V/ VAcknowledgement (1 original) Geotechnical Hazard Identification/Declaration & VMitigation Statement of Risk from Geotechnical V/ V/ V/ V/ V/ Engineer and Civil Engineer of Record (I original) Structural Engineer Declaration (I original) V11 V/ Applicant/Owner Covenant to Notify & Hold V/ V/ V/ V/ I/ Harmless (1 original) Vstamped Building Construction Plans (structural plans V V/ by Structural Engineer) Structural Calculations V/ V/ I/ V/ V/ Energy Code Compliance (shown on plans) I/ V/ V/ report Site Classification Worksheet (storm water) V/ V/ V/ V/ I/ Vstamped Civil Plans (Grading, Storm Drainage, TESC, Utilities) V/ V/ V/ V/ by Licensed Engineer TEID Right -of-Way Permit Application V/ Geotechnical Report V/ V/ V/ VLand Clearing/Tree Cutting Plan V/ V/ V/ city will complete Affidavit of "Notice of Application Posted at Job Site V/ v/ V/ V/ V/ TBID Washington State Contractors License V/ V/ V/ V/ TBD Contractor's City of Edmonds Business License V/ V/ V/ V/ V/ Plan Check Fee (due upon submittal) I/ V/ V/ V/ V/ N/A SEPA (grading, fill, excavation > 499 cycls. V/ V/ V/ V/ V/ Peer Review Fee +./ +,/ +./ +./ Administrative Review Fees V/ V/ TBD General Contractor Public Liability Insurance V/ V/ V/ Updated: 07/2020 • Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the design professional. • Seasonal Construction Period: limiting all excavation and drainage installation to the drier season (normally between May 11t and the end of September). During all work periods special inspections shall be performed after storm events as defined in ECDC 19.10.020(0). The Geotechnical Engineer shall make written, dated, reports on the progress of the construction and submit the reports to the Building Official on a weekly basis until all site grading, drainage, foundation and associated ground work is complete. At the completion of final site grading and all permitted structures, a final geotechnical report, prepared by the geotechnical engineer of record, shall be submitted to the Building Official. OV ED _410 0+ DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION FORM F S_ t. City of Edmonds 121 5th Avenue N, Edmonds, WA 98020 Phone 425.771.0220 MECHANICAL Equipment Type Appliance/Equipment Information (new and relocated) Total # Furnace #—Gas #—Elec #—Other: BTUs: <100k— >100k— Location Air Handler/AC/VAV #—Gas #—Elec #—Other: Heat PUMP CFM: <100k X >100k_ Location Mechanical Room Boiler/Compressor/ Heat # 1 Gas #—Elec #—Other: BTUs:X <100k,_100k-500k, _500k-lMil Pump/Roof Top Unit HP: _<3, _3-15, _15-30 Location Combi-Boiler for Furnance and Hydronic Heat Updated: 07/2020 Hydronic Heating #—Gas #—Elec —in-Floor, _Wall Radiant, Boiler BTUs: Location Exhaust Fans (single duct) Location: # 5 Bath # 1 Kitchen # 1 Laundry #_Other: 7 Fireplace # 1 Gas #—Elec #—Other: Location Living Room Other Number of Outlets FUELGAS Fixture/Appliance Type AC Unit ------------------ BTUS: 4111,20-0 Location: Mechanical Room Furnace ----------------- BTUs: Location: Water Heater ---------- BTUs: Location: Boiler -------------------- BTUs: 52,200 Location: Combi-Boiler Mechanical Room Fireplace/insert BTUs: 27,000 Location: Stove/Range/Oven: Duel Fuel Range/Oven Dryer Heat Pump Dryer Outdoor BBQ: Other: N/A TOTAL OUTLETS 3 PLUMBING FIXTURE Fixture Type COUNT Number Fixture Type Number 5 Water Closet (Toilet) Refrigerator water supply (for water/ice dispenser) 8 Sink (kitchen, laundry, lavatory, bar, eye wash, etc.) Water Service Line 3 Tub/Shower Drinking Fountain 1 Dishwasher Bidet/Urinal 6 Hose Bib Pressure Reduction Valve/Pressure Regulator 1 Water Heater Tankless? Yes X No— Backflow Prevention Device (e.g. RBPA, DCDA,AVB) Expansion Tank for Water Heater Hydronic Heat in: Floor X Wall- 1 Floor Drain/Floor Sink Other: 1 Clothes Washer Other: Updated: 07/2020