BLD2023-0227+OLD SCHOOL APPLICATION2.21.2023_3.43.25_PM+3380957e. 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:
Parcel: 004342-120-015-00 /004342-120-017-00
Lot /Unit/Suite #: 1 no Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: ETHAN STOWELL RESTAURANTS
Mailing Address:
2622 NW MARKET ST, SUITE A
City/state/zip: SEATTLE, WA 98107
Phone #: 253.486.3500
Email: KARA.SAMAC@ESRHOSPITALITY.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: Michael Picard
Mailing Address: 815 SEATTLE BLVD S., STE 108
City/state/zip: SEATTLE, WASHINGTON 98134
Phone #: 206.388.6962
E-mail: info@OkanoPicardStudio.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: WILCOX CONSTRUCTION INC.
Mailing Address:234 5TH AVE S
City/state/zip: EDMONDS, WA 98020
Phone #: 425.774.4185
E-mail: tness@wilcoxconstruction.com
STATE UBI #: 319007592
CITY OF EDMONDS BUSINESS LICENSE M WILCOC*194QC
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
December 10, 2023
Office Use Only
TYPE OF
❑Accessory Structure/
Detached Garage
Addition
❑
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: $750k
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished ❑
1st Floor, scl ft:
4664.65
2nd Floor, scl ft:
2060.17
Garage/Carport:, scl ft:
-
Deck/Covered Porch/Patio:
-
# of NEW Bedrooms: 0 # of NEW Bathrooms: 0
PROJECT•
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: Michael Picard
Signature: Date 02/21/2023
COMMERCIALGENERAL DATA
Occupancy Group(s): A_2 Occupant Load(s): 219
Type(s) of Construction: V-B 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
0
Tub/ Showers
0
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
10
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
7
Other:
Toilets
6
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
(New, Relocated or re piped)
Qty
Qty
Carbon Dioxide
0
Nitrous Oxide
0
Helium
0
Oxygen
0
Medical Air
0
Other:
Medical - Surgical Vacuum
0
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 ❑ Conditional Waiver ❑ Waiver❑
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
.D
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.