20170613154917.pdfDEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
1215 1h Avenue N, Edmonds, WA 98020
Phone 425.771.02200 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State Zip): Cj,6o Z.
--? -2�, Z 1 /2
Parcel #:
Subdivision/Lot #:
Project Valuation: $
APPLICANT:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
PROPERTY OWNER:
--3-E �i �5 6-yezA xr—,
Phone:
Fax:
Address (Street, City, State, Zip):
�7 3z i 0V-12 57 '54J EVM, 119024C.1
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
_1777—
CONTRACTOR:*
'S C I_h4 I- - —1-Z— M / I- L.---'K
Phone:
Address (Street, City,. �tatc, 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 LicqWe #/Exp. Dat
t P6 5q,2 ff T2,
City Business License #/Exp. Date:
9�t4 3 -7 L
DETAIL THE SCOPE OF WORK: Co tJ T / AJ 5-w,> A-r,�� Ar(" z tv —D
:5 eA PL-6 v n4 lPy -5 6 _14-1 v A X- 5- 16141 It L /V
Odcv4-:�� A-1 0 5,1 tsl ic� 6-v 4;`2 13 t4 ra
l,t-J 51-0 C-c- /,,v c.— L WJ , i- 00,J Ar 5 T , f,�11-- 0 PE=h' I A/Z'--
PROPOSED NEW SQUARE F
OTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished Ll Unfinished LJ
I" Floor: sq. ft.
Garage/Carport: sq. ft.
2 nd Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes
LJ
No
Retaining Wall: Yes
No
Grading: Cut —cu. yds. Fi I I cu.yds.
Cut/Fill in Critical Area: Yes L-1 No7
I declare under penalty 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:--3-o /A-Q!svDL_D Owner Agent/Other F',11 (specify): (fe
L IL"
Signature: Date:
FORM A LABuilding New Folder 2010\130NE & x-ferred to L-Building-New driveTorm A2014.docx Updated: 1/17/2014
0 F 1)
"
ej
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
1215 1h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 It Fax 425.771.0221
Equipment Type
Appliance/Equipment Information (new and relocated)
Total #
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-Mil
Roof Top Unit
HP:
<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
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
PLUMBING
Fixture Type (new and relocated)
FIXTURE COUNT
Total # Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
Pressure Reduction Valve/Pressure Regulator
Sink (kitchen, laundry, lavatory, bar, eye wash, etc.)
Water Service Line
Tub/Shower
J
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? Yes E] NoE]
Hydronic Heat in: FloorE] WallE]
Floor Drain/Floor Sink
ther:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A UTudding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.doex Updated: 1/17/2014
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING CHECKLIST
121 5" Avenue N, Edmonds, WA 98020
of Edmonds Phone 425.771.0220 ft Fax 425.771.0221
PROJECT ADDRESS:, 23ZI 02/-f 57— 54—)
Plans shall be Of sufficient clarity to indicate the location, nature, and extent of the work proposed, and conform to the provisions of
he adopted International Codes and City Ordinances.
� ;W_
SUBMIYTAL REQUIREMENTS
:z The number indicates [lie number of copiesfo?,
subinittal(ifap'plicable). Check marks indicate
m
E
additional submittal requirements that may
-9.
0.
apply to yo ur project.
A plication Form A
I I
Site Plan
3
Reduced Site Ian (I I X 14 or 8 ]/, x 11)
1
1
COnstruction Drawings
2
Structural Drawings and Calculations
2
Energy Code Compliance (shown on plans)
V/
2
V/
Site Classification - -- stormwater)
3
Draina C Plan/Stnrrnxv�t pi�n'
3
3
Draina�e Report or si�in& information on plan-,
3
3
Uradi IS Plan/Excavation/Fill
—Determination
3
3
Critical Areas or Checklist
I
Geotechnical Report > 14% slo e
3
I
Washington State Contractors License
V/ V/
3
V�
Contractor's City of Edmonds Busine License
V/ V/
Plan heck Fee (due upon submittal)
V/
Peer Review Fee
V/
Park Impact Fee Worksheet
V,
Fire Sprinkler plans and calculations — see footnote
3
oil
M—
M CD ft
n
511
CD
CrQ
PT,
00
3
3
3 3
1
1
1 1
2
2
2
2
2
2
V
3
3
3
3
1
1 1
3
3
V
V/ V/
V/
V/
V/
V/
0 Handouts and Standard Details may be found on the City's website or can be obtained at City Hall
during normal business hours. 3y���
0 Plans/calculation/reports prepared by state licensed architects or professional engineers must be stamped and signed by the
design professional.
0 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.
0 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 LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014