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DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
1215 1h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel 00513100006804
16330 72ND AVE W Edmonds WA 98026
Subdivision/Lot #:
Project Valuation: $
6139.00
APPLICANT: NORTHWEST PERMIT INC
Phone:
360-945-2787
Fax:
888-400-0383
Address (Street, City, State, Zip):
E-Mail Address:
9808 3 1 ST AVE SE, EVERETT WA 98208
naida@nwpermit.com
__rFax-
PROPERTY OWNER: DAVID WELLS
Phone:
206-779-9244
Address (Street, City, State, Zip):
E-Mail Address:
16330 72ND AVE W Edmonds WA 98026
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
Washington Energy Services Co LLC
800-398-4663
Address (Street, City, State, Zip):
E-Mail Address:
3909 196th St SW Lynnwood 99036
naida@nwpermit.com
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
WASHIES85 INS 9/7/2019
doing work in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
I NR- 022089 12/31/2017
INSTALL 8KW STANDBY GENERATOR BACKSIDE OF HOUSE OUT FROM DE
DETAIL THE SCOPE OF WORK:
ms rimNic Tzoii i r:
rizom IMM Elt Ar-ONC tIOUSE TO GENERA7nT
PROPOSED NEW SQUARE F
OTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select Basement Type: Finished Ll Unfinished Ll
Is'Floor: sq. ft.
Garage/Carport: sq. ft.
2 d Floor: sq. ft.
Deck/Cvrd Porch/Patio: sq. ft.
Bedrooms # Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes
U
No
U
Retaining Wall- Yes
[T
No
---
Grading: Cut cu. yds. Fill 77u.yds, I
Cut/Fill in Critical Area: Yes [_] No77
Ideclare underpenalty ofpeijury laws that the information I haveprovided on this formlapplication is true, correct and
complete, and that I am the property owner or duly authorized agent of the propeny owner to submit a permit application to
the City of Edmonds.
Print Name: NAIDA KHAN/NORTHWEST PERMIT INC.
Owner [:1 Agent/Other D (specify): AGENT
9/19/2017
Signature:
Date:
X
FORM A LABuilding New Folder 2010\130NE & x-ferred to L-Building-New driveTorm A2014.docx Updated: 1/17/2014
0
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
121 5'h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 111 Fax 425.771.0221
Equipment Type
MECHANICAL
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)
AC / Compressor
Boiler / Heat Pump
Gas # —
Elec #—Other:—
#_ BTUs:—<100k, 100k-500k, 500k-IMil
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 # #
duct)
_Other:
Fireplace
Gas #—Elec
#—Other:—
# Location(s)
Dryer Duct
FUEL GAS
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: —generat or
BTUs: 14-W
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
Drinking Fountain
Dishwasher
Clothes Washer
Hose Bib
Backflow Prevention Device (e.g. RBPA, DCDA, AVB)
Water Heater Tankless? YesE] No[—]
Hydronic Heat in: FloorE] WaIIE]
Floor Drain/Floor Sink
Other:
Refrigerator water supply (for water/ice dispenser)
Other:
FORM A L:\Building New Folder 2010\130NE & x-ferred to L-Building-New drive\Form A2014.doex Updated: Ifl 7/2014