BLD2020-1275+City_Application+11.22.2020_1.39.52_PM`°e. 1 %41
BUILDING PERMIT
APPLICATION Permit
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 permhs, schedule Inspections, or check applkodon status
go to: nts mybuildinavermitcom
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 132 Skyline Drive
Parcel:
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Kenneth Sund
Mailing Address: 132 Skyline Drive
City/State/Zip: Edmonds WA 98020
Phone #: 805-750-8672
Email: kennethgsund@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.er
Owner Signature: Kenneth Sund
Kth G Sd
Sig
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Kenneth G Sund
Mailing Address:
132 Skyline Drive
City/state/zip: Edmonds WA 98020
Phone #: 805-750-8672
E-mail: kennethgsund@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:_
City/State/Zip: _
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
TYPE OF PERMIT (Provide
❑Accessory Structure/
Detached Garage
Details on Page 2)
B/ 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 10
the nearest dollar) of off equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: $2500
PROPOSED NEW SOLIARE FOOTAGE FOP, THIS APPLICATION
Basement sg ft: Finished Unfinished
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
94
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT DESCRIPTION
Deck Addition to existing covered porch
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
agerrt of the property owner to submit a permit application to the City of
Edmonds.
Print Name: Kenneth G Sund
11-22-2
Signature: Date
Ocr-upancyGroup(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: Yes Noa
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WS£C forms.
DEFERRED SU8MrrrALS: 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
AFCHANICAL •
BTUs Gas / Eiec / other Qty
A/C Unit /Compressor
Air Handier /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
Oty My
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:
BTUs Qty BTUs Qty
A/C Unit
Outdoor B8Q/ Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
Refocatpd
City 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 #:
Critical Areas Determination:
('�
Study Required 0 Conditional Waiver [I Waiver!_}
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
�!.L/EXCAVATIF
Grading: Cut cubic yards
Fill cubit yards
CFill in Critical Area: Yes No
ln
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 7 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.