BLD2020-0675+City_Application+7.9.2020_12.27.48_PM100
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.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 809 Aloha Street
Parcel
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Douglas A Wohlman
Mailing Address: 809 Aloha Street
City/State/Zip: Edmonds/WA./98020
Phone #: 4257533302
Email: dougwohlman@yahoo.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.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Douglas A Wohlman
Mailing Address: 809 Aloha Street
City/state/zip: Edmonds/WA./98020
Phone #: 4257533302
E-mail: dougwohlman@yahoo.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:
Office Use.
Permit#: BLD2020-0675
TYPE OF PERMIT (Provide
❑ Accessory Structure/
Detached Garage
Details on Page 2)
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: 75000
PROPOSED.. FOR THIS APPLICATION
Basement scl ft: Finished❑ Unfinished ❑
1st Floor, scl ft:
2nd Floor, scl ft:
Garage/Carport:, scl ft:
334
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: Douglas A Wohlman
Digitally signed by Douglas A
Douglas A Wohlman Wohlman
Signature: Date, 2020.07.09 12 25 23 -07'00' Date
COMMERCIALGENERAL
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
EQUIPMENTMECHANICAL •
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
0
Air Handler /VAV
0
Boiler
0
Dryer Duct
0
Exhaust Fans
0
Fireplace
0
Furnace
0
Heat Pump Unit
0
Hydronic Heating
0
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
0
Other:
0
COUNTSPLUMBING FIXTURE
Qty Qty
Clothes Washer
0
Tub/ Showers
0
Dishwasher
0
Backflow Device (RPBA, DCDA, AVB)
0
Drinking Fountain
0
Pressure Reduction/ Regulator Valve
0
Floor Drain/Sink
0
Refrigerator Water Supply
0
Hose Bibs
0
Water Heater - Tankless? Y or N
0
Hydronic Heat
0
Water Service Line
0
Sinks
0
Other:
Toilets
0
Other:
COUNTSGAS/FUIEL CONNECTION d or re piped)
BTUs Qty BTUs
Qty
A/C Unit
0 Outdoor BBC,/ Fire pit
0
Boiler
0 Stove/Range/Oven
0
Dryer
0 Water Heater
0
Fireplace/ Insert
0 Other:
Furnace
0 Other:
COUNTSMEDICAL GAS, AIR VACUUM
(New, Relocated or re piped)
Qty Qty
Carbon Dioxide
0
Nitrous Oxide
0
Helium
0
Oxygen
0
Medical Air
0
Other:
0
Medical - Surgical Vacuum
0
Other:
0
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
GRADE/FILL/EXCAVATE
Grading: Cut 3 cubic yards
Fill 3 cubic yards
Cut / 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.