BLD2024-0519+OLD SCHOOL APPLICATION+4.17.2024_3.48.48_PM+4203412e. 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: 9521 240th St SW
Parcel: 27033600404600
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Edmonds School Dsitrict No. 15
Mailing Address:
20420 68th Ave W
City/State/Zip: Lynnwood, WA 98036
Phone #: 425-431-7162
Email: choun@edmonds.wednet.edu
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: Nick Chou
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Stephen Murakami
Mailing Address: 4010 Lake WA Blvd NE, Suite 320
City/State/Zip: Kirkland, WA 98033
Phone #: 425-828-8948
E-mail: smurakami@hoarch.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Pacific Mobile Structures, Inc.
Mailing Address:13806 45th Ave NE
City/State/Zip: Marysville, WA 98271
Phone #: 360-572-5010
E-mail: patrick.allen@pacificmobile.com
STATE UBI #: 600-498-022
CITY OF EDMONDS BUSINESS LICENSE #: 600-498-022
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
PACIFMS033DC - exD. 11/8/24
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: $109,000
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished ❑
1st Floor, scl ft:
831 sf
2nd Floor, scl ft:
Garage/Carport:, scl ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
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: Stephen Murakami
Stephen Murakami ° m'�a° 4/16/24
Signature: "m' Date
COMMERCIALGENERAL DATA
Occupancy Group(s): E Occupant Load(s): 42
Type(s) of Construction: VB Fire Sprinklers: Yes❑ NoFf]
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
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:
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.