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APPLICATIONof EDM0 BUILDING PERMIT v �d APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 Inc t Aq0 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: http://www.edmondswa.gov/ JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 55t-I Paradise Lane, Building C Parcel: 27032600302600 Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: Paradise Heights HLD LLC Mailing Address: 24144 E. Greystone Lane City/state/Zip: Woodway, WA 98020 Phone #: 425-750-5965 Email: jsrett@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: Rob Michel Mailing Address: 7305 Soundview Drive City/State/Zip: Edmonds, WA 98026 Phone #: 206-930-2445 E-mail: rwmichel@nwlink.com GENERAL CONTRACTOR: (If different from applicant) General Contractor: Regent Construction, Inc. Mailing Address: City/State/Zip: _ Phone #: E-mail: 7305 Soundview Dr Edmonds, WA 98026 206-930-2445 rwmichel@nwlink.com WA STATE CONTRACTOR L & I # (CCB) & EXPI�TION DATE: REGENC1891 K5 CITY OF EDMONDS BUSINESS LICENSE #: BL-010892 PermiT #: TYPE OF ❑ Accessory Structure/ Detached Garage Details on Page ❑ 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 sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: j"-7 2nd Floor, sq ft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: p� Jr rf 0 Other sq ft: PROJECT 4 unit Condominium 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. Robin W. Michel Print Name - Signature: Date 1/1619 GENERALDATA Occupancy Group(s): R 1, U Occupant Load(s): Type(s) of Construction: VA 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 MECHANICAL EQUIPMENT COUNTS (New and Relocated) BTUs Gas / Elec / Other City A/C Unit /Compressor Air Handler/VAV Boiler Dryer Dud 4 Exhaust Fans Elec 16 Fireplace 30k 4 Furnace Heat Pump Unit Hydronic Heating 199k Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE ••• Deffered Qty Qty Clothes Washer 4 Tub/ Showers 8 Dishwasher 4 Backflow Device (RPBA, DCDA, AVB) 1 Drinking Fountain Pressure Reduction/ Regulator Valve 1 Floor Drain/Sink Refrigerator Water Supply 4 Hose Bibs 2 Water Heater - Tankless? Y r N 4 Hydronic Heat 4 Water Service Line 1 Sinks 20 Other: Toilets 8 Other: CONNECTION• .. re -piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven 35k 4 Dryer 25K 4 Water Heater 199k 4 Fireplace/ Insert 30K 4 Other: Furnace Other: MEDICAL.COUNTS Relocated . re -piped) Qty Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: Type of structure to be demolished: Square footage of structure to be demolished: AHERA Survey done? Y / N PSCAA Case N: 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 ❑ •.• Grading: Cut 1,067 cubic yards Fill 28 cubic yards Cut / Fill in Critical Area: Yes ❑ No GENERAL PROVISIONS 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.