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BLD2024-0284+OLD SCHOOL APP +3.1.2024_11.11.07_AM+4095654BUILDING 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.mybuildingpermit.com JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job site Address: 19210 Olympic View Dr, Edmonds Parcel: 00425100000700 Lot /Unit/Suite #: Subdivision: C:hittPndPn Addr BUSINESS OR PROPERTY OWNER: Name: Braun Living Trust Mailing Address 19210 Olympic View Dr City/State/Zip: Edmonds, WA 98020 Phone #: 608-347-7188 Email: webraun2@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: William F Braun Mailing Address: 19210 Olympic View Dr City./State/Zip: Edmonds, WA 98020 Phone #: 608-347-7188 E-mail: webraun2@gmaii.com GENERAL CONTRACTOR: (if different from applicant) General Contractor: RTI Services LLC Mailing Address 2006 196th St. SW Suite 116 City/State/Zip: Lynnwood, WA 98036 Phone #: 206-948-1851 E-mail: tj@rtiserviceslic.com STATE UBI #: 603 250 920 CITY OF EDMONDS BUSINESS LICENSE #: 603 250 920 WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: RTISESL878JA 04/03/2025 Office Use Only 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: I 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: Finished❑ Unfinished 1st Floor, scl ft: 2nd Floor, scl ft: Garage/Carport:, scl ft: Deck/Covered Porch/Patio: 528 sq.ft.+ steps - deck # of NEW Bedrooms: # of NEW Bathrooms: PROJECT DESCRIPTION gem ove 61CI ejeck �,©�- I YiC'NI •IL�/e i151�4 /rir�Itv Ir15 ri�f 7/S Le,- c4'Pt+'0cdiinGs 2be er%G fPG+,J a:ieck oet'i reck A.t r1l z t S//f' ff 5 %j�7 Ile,- flyi(- 4 k t IV I ��fPny YP�f?%`V ,IV AkriL�T i'art�let� Ra;�r�4 l)WNh�r(ems�'! (J1 rFSS+tae �ctitxeeess i I , 1 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 NameWilliam F Braun j� f J''� Signature: vi✓r�'� �t� Date's GENERAL• 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 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 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 Relocated or piped) Qty Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: DEMOLITION Type of structure to be demolished: Current deck Square footage of structure to be demolished: 757 Sq.ft. AHERA Survey done? Y❑/ N❑✓ PSCAA Case #: Critical Areas Determination: Study Required 0 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 ❑ No ❑ 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.