BLD2023-1028+PAPER APPLICATION+8.14.2023_12.23.12_PM+3723971e. I Rye
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.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinapermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 19804 86TH PL W
Parcel: 005652-000-011-00
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: WILLIE AND WHITNEY CURRY
Mailing Address: 19804 86TH PL W
City/state/zip: EDMONDS / WA / 98026
Phone #: 206-295-8123
Email: whitneytcurry@gmail.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: LUIS F. SIALER
Mailing Address: 16008 MOTOR PL
City/state/zip: LYNNWOOD / WA / 98087
Phone #: 425-877-7377
E-mail: sialerdesign@icioud.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: T.B.D.
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
❑Accessory Structure/
Addition
Detached Garage
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,
and the profit for the work indicated on this application.
Valuation: 75,000
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished ❑
1st Floor, scl ft:
470
2nd Floor, scl ft:
Garage/Carport:, scl ft:
400
Deck/Covered Porch/Patio:
# of NEW Bedrooms: N/A # of NEW Bathrooms: N/A
PROJECT•
ON AN ONE STORY SINGLEN FAMILY RESIDENCE CONVERT PART OF THE EXISTING GARAGE INTO LIVING SPACE, AND ADD W SF
OF GARAGE ADDITION
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.
LUIS F. SIA ER
Print Name:
08/01 /23
Signature: G Date
COMMERCIALGENERAL 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 / Elec / Other Qty
A/C Unit /Compressor
Air Handler/VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
9000
ELECTIC
1
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE d or re piped)
Qty Qty
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device (RPBA, 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
1
Other:
Toilets
Other:
CONNECTION COUNTSd or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
COUNTSMEDICAL GAS, AIR VACUUM
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: NSA
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ N❑
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
.D
Grading: Cut 10 cubic yards
Fill 6 cubic yards
Cut / Fill in Critical Area: Yes ❑ No RI
GENERAL•• •
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.
DocuSign Envelope ID: 7D8B23B1-7956-49F4-8F25-3DF4EB579251
#P20
Critical Areas File #:
❑ Initial Determination - $110
❑ Subsequent Determination - $55
Date Received:
Date Mailed to Applicant:
The purpose of this checklist is to enable City staff to
determine whether any critical areas and/or buffers are
located on or adjacent to the subject property. Critical
areas, such as wetlands, streams and steep slopes, are
ecologically sensitive or hazardous areas that are
regulated to protect their functions and values. The City's
critical area regulations are contained within Edmonds
Community Development Code (ECDC) Chapters 23.40
through 23.90.
Property Owner's Authorization
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
www.edmondswa.gov
A property owner, or an authorized representative, must
fill out the checklist, sign and date it, and submit it to the
City. Staff will review the checklist, conduct a site visit,
and make a determination of whether there are critical
areas and/or critical area buffers on or near the site. If a
"Critical Area Present" determination is issued, a report
addressing the applicable critical area requirements of
ECDC Chapters 23.40 through 23.90 may be required
depending on the scope of the proposed activity.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject
property for the purposes of inspection attendant to this application. The undersigned owner, and his/her/its heirs, and
assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of
Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction
based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its
agents or employees. /—DocuS;9ned by:
� ���� ��,�y�y� Aug 1, 2023
SIGNATURE OF OWNER �' ' -I �E I �DATE
Owner:
WILLIE AND WHITNEY CURRY
Name
19804 86TH PL W
Street Address
EDMONDS, WA 98026
City State Zip
Telephone:
206-295-8123
Email address:—whitneycurry@gmail.com
Applicant/Agent:
LUIS F. SIALER
Name
16008 MOTOR PL
Street Address
LYNNWOOD, WA 98087
City State Zip
Telephone:
425-877-7377
Email Address: sialerdesign@icloud.com
Revised on 114117 P20 - Critical Areas Checklist Page 1 of 2
DocuSign Envelope ID: 7D8B23B1-7956-49F4-8F25-3DF4EB579251
CA File No:
Critical Areas Checklist
Site Information
1. Site Address/Location: 19804 86TH PL W, EDMONDS, WA 98026
2. Property Tax Account Number: 005652-000-011-00
3. Approximate Site Size (acres or square feet): 0.28 ACRES
4. Is this site currently developed? ❑ Yes X No
If yes, how is the site developed?
5. Describe the general site topography. Check all that apply.
X Flat to Rolling: No slope on/adjacent to the site or slopes generally less than 15% (a vertical
rise of 10-feet over a horizontal distance of 66-feet).
❑ Moderate: Slopes present on/adjacent to site of more than 15% and less than 40% (a vertical
rise of 10-feet over a horizontal distance of 25 to 66-feet).
❑ Steep: Slopes of greater than 40% present on/ to site (a vertical rise of 10-feet over a
horizontal distance of less than 25-feet).
6. Have there been landslides on or near the site in the past? ❑ Yes IX No
If yes, please describe:
7. Site contains areas of year-round standing water? ❑ Yes (approx. depth: ) X No
8. Site contains areas of seasonal standing water? ❑ Yes (approx. depth: ) No
If yes, what season(s) of the year?
9. Site is in the floodway or floodplain of a water course? ❑ Floodway ❑ Floodplain N/A
10. Site contains a creek or an area where water flows across the grounds surface? ❑ Yes No
If yes, are flows year-round or seasonal? ❑ Year-round ❑ Seasonal (time of year: )
11. Obvious wetland is present on site? ❑ Yes X No
11 3.
Zoning:
SCS mapped soil type(s):
For City Staff Use Only
13. Critical Areas inventory or C.A. map indicates Critical Area on site:
14. Site within designated North Edmonds Earth Subsidence and Landslide Hazard Area (ESHLA)?
DETERMINATION
CRITICAL AREAS PRESENT
Reviewed by:
WAIVER
Revised on 114117 P20 - Critical Areas Checklist Page 2 of 2