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REVISED APPLICATIONBUILDING PERMIT MM APPLICATION 7P-,mtrr: BLD2021-0208 Development Services Building Division 121 Sfh 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.mvbuildinanermit. com JOB SITE INFORMATION/LOCATION: (Where the work Is taking place) Job site Address: 507 3rd ave s edmonds wa Parcel: 00409600100102 Lot /Unit/Suite #: Subdivision: BUSINESS OR PROPERTY OWNER: Name: Gary and Charlene Ramm Mailing Address: 5011 19th Ave N City/State/Zip: Seattle, WA 98105 Phone #: 206-524-4116 Email: garyramm77@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: Gary Ramm APPLICANT / CONTACT INFORMATION: Name of Applicant: Gary & Charlene Ramm Mailing Address: 5011 19th Ave NE City/state/zlp: Seattle WA 98105 Phoneit: 206-524-4116 E-mail: garyramm@gmail.com GENERAL CONTRACTOR: (If different from applicant) General contractor: Vic Johnson Mailing Address:6618 Marine View Dr city/state/zip: Edmonds, WA 98026 Phone #: 425-308-3961 E-mail: jasconstnw@gmail.com STATE uel #. 602 807 834 CITY OF EDMONDS BUSINESS LICENSE M JOHNSSC92116 WA STATE CONTRACTOR L & I M (CCB) & EXPIRATION DATE: 05/09/2008— 05/09/2022 TYPE Of e Accessory Structure/ Detached Garage Details Addition Demolition 1:1Mechanical New Single Family/Duplex © Plumbing ElFire Sprinkler W1 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, matedals, labor, overhead, and the profit for the workindicated on this application. Valuation: 125,000 PROPOSED•UARE FOOTAGE FOR THIS APPLICATION Basement sg ft: Finished❑ Unfinished 1st Floor, sgft: 2nd Floor, sgft: Garage/Carport:, sg ft: Deck/Covered Porch/Patio: 402.5 #of NEW Bedrooms: PROJECTDESCRIPTION # of NEW Bathrooms: I certify that the information I have provided on this form/application is true, correct and complete, and that lam the property owner or duly authorized agent of the property owner to submit a permit application to the City of Edmonds. Print Name: 6 4 ✓"J /� OI iiM � y Signature: ✓/i^ Date � • „GENERAL COMMERCIAL Occupancy Group(s): Occupant Load(s): Type(s) of Construction: Fire Sprinklers: Yes El 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 1 Dryer Duct Exhaust Fans 5 Fireplace Furnace Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE Qtv QtY Clothes Washer Tub/Showers Dishwasher Backflow Device (RPBA, DCDA, AVB) ' Drin king Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink I Refrigerator Water Supply 0 Hose Bibs 3 Water Heater-Tankless? Y oro Hydronic Heat Water Service Line Sinks 6 Other: Toilets 3 Other: BTUs My BTUs Qty A/C Unit Boiler Dryer Fireplace/ Insert Furnace Carbon Dioxide Helium Medical Air Medical - Surgical Vacuum Outdoor BBQ/ Fire pit Stove/Range/Oven Water Heater l Other: Other: Type of structure to be demolished: Nitrous Oxide Oxygen Other: Other: Square footage of structure to be demolished: AHERA Survey done?Y❑/ N[] PSCAA Case #: Critical Areas Determination: Study Required El Conditional Waiver❑ Waiver❑ Fill In Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) _ Critical Areas Determination: Study Required Conditional Waiver Waiver Grading: Cut cubic yards Fill cubic yards Cut/ Fill in Critical Area: Yes I I No n APPUCATIONS: Applications are valid for a maximum of Iyear. 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.