Osborne-McKenna Garage Modification Building_Permit_Permit_Application_2019TYPE OF PERMIT (Provide Details on Page 2)
□ Accessory Structure/
Detached Garage
□ Addition
□ Demolition
□ Mechanical
□ New Single Family / Duplex
□ Plumbing
□ Fire Sprinkler
□ Remodel
□ New Commercial/ Mixed Use
□ Re-Roof
□ Signs
□ Tank
□ Tenant ImprovementxOther turn garage into room
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:
$2000
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATIONBasementsqft:Finished □Unfinished□
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:,sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
Turning our 1 car garage into an enclosed room in the house.
Modifications include: replacing garage door opening with new 2x6 wall with slider window; putting down sleeper floor on existing concrete grade made up of: 6 mil vapor barrier + 2x6
PT joists and ledgers + 5/8” plywood sheathing, then finish floor.
Existing garage has lights, outlets, insulation and drywall
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.PrintName: Signature:Date
BUILDING PERMIT APPLICATION
Development Services Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection scheduling information go to:www.edmondswa.gov.
PLEASE NOTE: Intake appointments are required for New Single Family Residences, Large Additions, ADU’s, New Commercial, and Major Tenant Improvement application submittals. If plans
are prepared by a profession- al, electronic files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer.
Please call 425-771-0220 to schedule an intake appointment!JOB SITE INFORMATION/LOCATION: (Where the work is takingplace) JobSiteAddress: 10102 241ST Pl SWParcel: Lot/Unit/Suite#:Subdivision:
PROPERTY OWNER:Name: Rick McKenna and April OsborneMailingAddress: 10102 241st PL SWCity/State/Zip: Edmonds, WA 98020 Phone#: 206-407-6481Email: april.osborne@ymail.comOWNERINSTALLATION:*If
yes, read andsign*
Will work be performed by the property owner? xYes □ 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.OwnerSignature: Rick McKenna/April Osborne
APPLICANT / CONTACT INFORMATION:NameofApplicant: Same as aboveMailingAddress: City/State/Zip: Phone#:E-mail:
GENERAL CONTRACTOR: (If different from applicant)GeneralContractor:MailingAddress:City/State/Zip: Phone#:E-mail:STATEUBI#: CITY OF EDMONDS BUSINESSLICENSE#: WA STATE CONTRACTOR L &
I #: (CCB) & EXPIRATIONDATE:
GENERAL COMMERCIAL 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 (New and Relocated)
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:
PLUMBING FIXTURE COUNTS (New, Relocated 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:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)
BTUs
Qt
y
BTUs
Qty
A/C Unit
Outdoor BBQ / Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated 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:StudyRequired□Conditional Waiver □ Waiver□
TANKFill inPlace□FillMaterial:
Removal □Size of Tank(Gallons)
Critical Areas Determination:StudyRequired□Conditional Waiver □ Waiver□
GRADE/FILL/EXCAVATEGrading:CutcubicyardsFillcubicyardsCut / 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.