BLD2020-0865+City_Application+8.19.2020_1.10.32_PM`'IC. l g`t�'
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswo.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: 8344 Olympic View Dr
Parcel: 27041800109300
Lot /Unit/Suite #: R Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Vector One, LLC
Mailing Address: PO BOX 13377
City/State/Zip: Everett, WA 98206
Phone #: 425-791-3253
Email: mbolin@usacmtg.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: Vector One, LLC
Mailing Address: PO BOX 13377
City/State/Zip: Everett, WA 98206
Phone #: 425-791-3253
E-mail: mbolin@usacmtg.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: C C Construction
Mailing Address 8415 192nd St SW
City/State/Zip: Edmonds, WA 98026
Phone #: 206-714-9429
E-mail: carclp@comcast.net
STATE UBI #: 600 141 783
CITY OF EDMONDS BUSINESS LICENSE #: BL006521
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
CCCON**110RF 10-12-2021
Office Use Only
(ProvideTYPE OF PERMIT
Structure/
Detached Garage
Details on Page 2)
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:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished❑
1st Floor, scl ft:
5592
2nd Floor, scl ft:
2738
Garage/Carport:, scl ft:
1026
Deck/Covered Porch/Patio:
182
# of NEW Bedrooms:3
PROJECTDESCRIPTION
# of NEW Bathrooms:2,5
I
I
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
I Edmonds.
Print Name: Ste Shear
Signature: Date
GENERAL COMMERCIAL.
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: S FR
Fire Sprinklers: Yes 0No El
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
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Elec
1
Exhaust Fans
6
Fireplace
Furnace
Gas
1
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUMBING FIXTURE COUNTS (New, Relocated or re piped)
Qty Qty
Clothes Washer
Tub/ Showers
2
Dishwasher
1
Backflow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
1
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
2
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
8
Other:
Toilets
4
Other:
GAS/FUEL CONNECTION COUNTS (New., Relocated or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ / Fire pit
1
Boiler
Stove/Range/Oven
Dryer
Water Heater
1
Fireplace/ Insert
Other:
Furnace ') Other:
MEDICAL GAS.. AIR VACUUM COUNTS
(New, Relocated 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:
Square footage of structure to be demolished:
AH ERA Survey done? Y❑ / N❑
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver❑
Fill in Place El Fill Material:
Removal El
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
•.DEXCAVATE
Grading: Cut 300 cubic yards
Fill 50 cubic yards
Cut / Fill in Critical Area: YesEl No `/
GENERALPROVISIONS
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.