BLD20160804.pdfa DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
goo 121 5"' Avenue N, Edmonds, WA 98020
t. 1
City of Edmonds Phone 425.771.0220 9 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJ ECT ADDRESS (SAI*, Suite # City State, Zip):
Parcel #:
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Subdivision/Lot #:
Project Valuation: $
AP ICAN":
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E -Mail Address:
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E -Mail Address: ®® I
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LENDING AGENCY: fPhone:Fax:
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Address (Street, City, State, Zip):
E -Mail Address:
CONTRA FOR.
Phone:
Fax:
Address (Street, City, State, Zip):
E -Mail Address:
10 F 1
2
WA State License #/Exp. ate:
*Contractor must have a valid City of Edmonds business license
prior to2
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Cily PAusiness License # Exp. ate:
doing work in the City. Contact the City Clerk's Office at 425.775.2525
DETAIL THE SCOPE OF WORK:
PROPOSED NEW SQUARE F OTAGE FOR THIS PROJECT:
Basement: —sq. ft.
Select Basement Type: Finished Unfinished
1" Floor: sq. ft.
Gari e/Car ort: sq. ft.
2"0 Floor: —sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full -3/4 Bath # Half -Bath #
Other: sq. ft.
Fire S rinklers: Yes NoF I
I Retaining Wall: Yes No
Grading: Cut cu. yds. Fill cu.yds.
I Cut/Fill in Critical Area: Yes 0 No
I declare under penalty of'perjuiy laws 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.
k0b J0 A1-
Owner ❑ Agent/Other ❑ (specify):
Print Name:
Signature: Ant,
Date:
has
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FORM A L:ABuilding New Folder 2010vDONE & x-ferred to L -Building -New driveTorm A2014.docx Updated: 1/17/2014
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DEVELOPMENT SERVICES
' RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
Fs r. 1 X90 121 5°i Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 A Fax 425.771.0221
Equipment Type
BTUs:
Appliance/Equipment Information (new and relocated) Total #
Location(s):
Appliance/Equipment Information (new and relocated) Total #
Furnace
Gas #_Elec
#_Other:
# BTUs: <100k_ >100k_
Location(s)
Air Handler / VAV
Gas #
Elec #_Other:
#_CFM: <10k_ >10k
Location(s)
(circle selected)
Fireplace/Insert
BTUs:
_ Location(s):
Stove/Range/Oven
AC / Compressor /
Other:
Dryer
Other:
Boiler / Heat Pump /
Gas #_Elec
#_Other:
#_ BTUs: <100k,
100k -500k, 500k-1Mil
Roof Top Unit
hip:
<3,
3-15, 15-30 Location(s)
(circle selected)
Hydronic Heating
Gas #_Elec
#_In
-Floor _Wall Radiant_ Boiler BTUs:
Location
Exhaust Fans (single
Bath #_Kitchen
#_Laundry # Other:
#
duct)
Fireplace
Gas #_Elec
#_Other:
# Location(s)
_
Dryer Duct
14JEJ
Appliance Type
AC Unit
BTUs:
Appliance/Equipment Information (new and relocated) Total #
Location(s):
Furnace
BTUs:
^ Location(s):
Water Heater
BTUs:
Location(s):
Boiler
BTUs:
Location(s):
Other:
BTUs:
Location(s):
Fireplace/Insert
BTUs:
_ Location(s):
Stove/Range/Oven
Other:
Dryer
Other:
Outdoor BBQ
TOTAL OUTLETS
Fixture Type (new and relocated)
Water Closet (Toilet)
Total #
Fixture Type (new and relocated) Total #
Pressure Reduction Valve/I'ressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
Tub/Shower
Drinking Fountain
Dishwasher
Clothes Washer
hose Bib
Backflow Prevention Device (e.g. RseA, ocDA, AVB)
Water heater Tankless? Yes ❑ No[:]
Hydronic Heat in: Floor Wall
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A L:ABLIdding New Folder 2010\DONE & x-ferred to L -Building -New driveAForm A2014.docx Updated: 1/17/2014
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING CHECKLIST
121 5°i Avenue N, Edmonds, WA 98020
Phone 425.771.0220 ft Fax 425.771.0221
City of Edmonds
PROJECT ADDRESS:
Plans shall be of sufficient clarity to indicate the location, nature, and extent of the work proposed, and conform to the provisions of
the adopted International Codes and City Ordinances.
• Handouts and Standard Details may be found on the City's website www.edmondswa.2ov or can be obtained at City Hall
during normal business hours.
• Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the
design professional
• Sidehill or steep slope construction is not considered conventional construction and soils reports are required for lots with
15% or more slope, unless determined unnecessary by the Building Official.
• New one -family, two-family, and townhouses, with a fire area greater than 3,000 sq. ft., and IRC buildings containing 5 or
more attached dwelling units, require automatic fire sprinkler systems under separate permit. "Fire area" typically includes
interior living space plus exterior covered decks and patios, but excludes attached garages constructed with required
separation from the dwelling.
FORM A L:ABuilding New Folder 2010vDONE & x-ferred to L -Building -New drivevForm A2014.docx Updated: 1/17/2014
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SUBMITTAL REQUIREMENTS
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The number indicates the number of copies for
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submittal( if applicable). Check marks indicate
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additional submittal requirements that may
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apply to your project.
Application Form A
1
1
1
1
1
1
1
Site Plan
3
3
3
3
3
3
3
Reduced Site Plan (I 1 X 14 or 8 '/2 x 11)
1
1
1
1
1
1
Construction Drawings
2
2
2
2
2
Structural Drawings and Calculations
2
_2
2
2
2
Energy Code Compliance (shown on plans)
✓
✓
✓
Site Classification Worksheet (stormwater)
3
3
3
Drainage Plan/Stormwater Plan
3
3
3
Draina e Re ort or sizing information on plans
3
3
3
Grading Plan/Excavation/Fill
3
3
3
Critical Areas Determination or Checklist
I
1
_
I
1
1
Geotechnical Report > 14% slope
3
3
3_
3
_
Washington State Contractors License
✓
✓
✓
✓
✓_
✓
✓
Contractor's City of Edmonds Business License
✓
✓
✓
✓
✓
✓
✓
Plan Check Fee (due upon submittal)
✓
✓
✓
✓
✓
Peer Review Fee
✓
✓
✓
✓
Park Impact Fee Worksheet
✓
✓
Fire Sprinkler plans and calculations — see footnote
3
• Handouts and Standard Details may be found on the City's website www.edmondswa.2ov or can be obtained at City Hall
during normal business hours.
• Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the
design professional
• Sidehill or steep slope construction is not considered conventional construction and soils reports are required for lots with
15% or more slope, unless determined unnecessary by the Building Official.
• New one -family, two-family, and townhouses, with a fire area greater than 3,000 sq. ft., and IRC buildings containing 5 or
more attached dwelling units, require automatic fire sprinkler systems under separate permit. "Fire area" typically includes
interior living space plus exterior covered decks and patios, but excludes attached garages constructed with required
separation from the dwelling.
FORM A L:ABuilding New Folder 2010vDONE & x-ferred to L -Building -New drivevForm A2014.docx Updated: 1/17/2014