BLD2024-1465+PAPER APPLICATION+11.6.2024_10.42.36_AM+4604614BUILDING PERMIT
APPLICATION Permit#:
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020 TYPE OF PERMIT (Provide Details on Page 2)
425.771.0220
11jC, I89"
For handouts, submittal requirements go to: www.edmondswa.yov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingaermhLcom
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 20710 86TH PL W
Parcel: 00544600001300
Lot /Unit/Suite #: 13 Subdivision: Pine Ridge
BUSINESS OR PROPERTY OWNER:
Name: JOSEPH & JANET LEWIS
Mailing Address: 20710 86TH PL W
City/state/zip: EDMONDS, WA 98026
Phone #: 425-417-2751
Email: lopus7@gmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? 7Yes ❑ 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 ...a,
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Brett Westlund LZL Construction,
Mailing Address: 10604 E. Riverside Drive
City/State/Zip: Bothell, WA 98014
Phone #: 425-485-3877
E-mail: brett@lzlconstruction.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Accessory Structure/
Addition
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
a Remodel
New Commercial/Mixed Use
El Re -Roof
Signs
❑ Tank
Tenant Improvement
ElOther
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:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
109 PORCH, 221 DECK
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT
•REMODEL OF KITCHEN, LAUNDRY, - I
`BEDROOMS AND BATHROOM WITH
INTERIOR STRUCTURAL REVISIONS.
CONSTRUCT NEW DECK AND PORCH
7R00F. REPLACE WINDOWS AND
_''DOORS.
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 I
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: Brett Westlund
Signature: U�2Q(�Q��G Date 11-6-24
1
GENERAL• .DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
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
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Elec
1
Exhaust Fans
Elec
3
Fireplace
25000
Gas
1
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE Relocated or re piped)
Qty Qty
Clothes Washer
Tub/ Showers
2
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
N
Hydronic Heat
Water Service Line
Sinks
3
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
1
Dryer
Water Heater
Fireplace/ Insert
25000
Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
Relocated or
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❑
ONEEMEMEEMEW
Fill in Place ❑ Fill Material:
Removal ❑
Size of Tank (Gallons)
Critical Areas Determination:
Study Required Conditional Waiver Waiver
•.•
Grading: Cut 0 cubic yards
Fill 0 cubic yards
Cut / Fill in Critical Area: Yes ❑ 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.