20170130154038.pdf0 V. ED_4
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10
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
11, IS90 121 5th Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 It Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJ��T ADDRES�!�ee;e *
01 r
0) ugve
#, City State, �ip)�.
C,
Parcel #:
Subdivision/Lot #:
Project Valuation: $
APPLICANT: aL
9-1 u�_,;
Y4.1't's
Phone:
CPA - jg 0 - I A 5�
F ax:
Address (Street, City,stalp, Zip):
p 173 12 &,.,a /-J
FLy JS 9L)a
E-M *1 Address:
PROPERTY OWNER:
r
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
1�� AGENCY:
Phone:
Fax:
^ (Street, City, State, Zip):
E-Mail Address:
CON4TR#CTOR:*
Phone:
Fax:
Address i(Street, City, State, Zip):
E-Mail Address:
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
WA State License #/Exp. Date:
City Business License #/Exp. Date:
DETAIL THE SCOPE OF WORK:
MOW W04_T1"fMZ11.-4_ N —
an tnL C__
PROPOSED NEW SQUARE FOOTAGE
FOR THIS PROJECT:
Basement:
sq. ft.
Select Basement Type: Finished Ll Unfinished U
I't Floor:
sq. ft.
Garage/Carport: sq. ft.
2"" Floor:
sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath #
Half -Bath #
sq. ft.
Fire Sprinklers: Yes
-7
LJ No
-Other:
Retaining Wall: Yes L]
No
Ll
Grading: Cut -cu. yds.
Fill _cu.yds.
Cut/Fill in Critical Area: Yes E] No L_]
I declare underpenalty ofperjury laws that the information I have provided on this formlapplication 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 Owner)��Agent/Other El (specify):
Signature: Date: J -3o- (7
'a -
FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014
0" E D,V
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
121 5"Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 ft Fax 425.771.0221
Oil �11� I
Equipment Type
M
Appliance/Equipment Information (new and relocated) #
Furnace
Gas #
Elec # Other:
# BTUs: <100k. >100k— Location(s)
Air Handier / VAV
Gas #—Elec
#—Other:--
#—CFM: <10k— >10k— Location(s)—
(circle selected)
AC / Compressor
Boiler / Heat Pump
Gas #—Elec
#—Other:—
#_ BTUs:—<100k, 100k-500k, 500k-lMil
Roof Top Unit
HP:
<3,3-15,15-30
Location(s)
(circle selected)
Hydronic Heatmg
Gas #—Elec
#—In-Floor
Wall Radiant— Boiler BTUs: Location
Exhaust Fans (single
Bath #
Kitchen # Laundry #
duct)
—Other:
Fireplace
Gas #—Elec
#—Other:
# Location(s)
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs:
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
Dryer
Outdoor BBQ
TOTAL OUTLETS
Fixture Type (new and relocated)
77
Total # Fixture Type (new and relocated)
TO 1#
Water Closet (Toilet)
Pressure Reduction Valve/Pressure 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. RBPA, DCDA, AVB)
Water Heater Tankless? Yes
0 NoE]
Hydronic Heat in: Floor Wall E]
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A L:\Building New Folder 201000NE & x-ferred to L-Building-New drive\Form A2014.doex Updated: 1/17/2014
OV E Op
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 01/30/2017 Permitft: BLD20170149
Expiration Date: 07/31/2017 1'n)jedAddjvss: 180 [2 73RD AVE NNI, EDMONDS
Parcel No: 00477500005200
7,izo RTIT 0NNIN FR APPLICANT ('ONTRA(A'011
BRIAN & KRISTIN EASTLAND BRIAN & KRISTIN EASTLAND BRIAN & KRISTIN EASTLAND
P 0 BOX 758 P 0 BOX 758 P 0 BOX 758
EDMONDS, WA 98020 EDMONDS, WA 98020 EDMONDS, WA 98020
LICENSE EXP:
�mlfumm_
FINAL INSPECTION FORNEW FURNACE (Bl-D2015-135 1)
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 40 - Mechanical
GRADING. N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY
GROUP
OCCUPANT LOAD:
FENCE: OXO FT)
CODE:
OTHER: ------- OTHER DESC:
IZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT- 0 IS7 FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
1 BEDROOMS: 0 BATHROOMS: 0
FR0N'I'SFI'BA('K SIDFSI—I'BA('I-. It EA It S FFBA('k
REQUIRED: PROPOSED: IrEQUIRED: ------ IREQUIRED: PROPOSED
HEIGHT ALLOWED:O PROPOSED:0 IREOUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
MS-AXPLICATION IS NG;r/\ PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR AND ALL FEES ARE PAID.
—X./ A-, �j - -7
e>- -30-17 T��'j) (15011
1(--,,'Sign-kure -1,J Print Name Date Released By Date?
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED UBC109/IBC110/UZCIIO.
ONLINE APPLICANT ASSESSOR OTMR