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BUILDING PERMIT
APPLICATION
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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 taking place)
JobSiteAddress: 2,!50 fracL��' i)_14
Parcel: ? 0 3 A 33� C' ag_ C5 c)
Lot /U niVefte �#
Subdivision:
PROPERTY OWNER: 5k?""
Name: �5&'Mk 1 ; e— V) !�J NOA Ivi
Mailing Address: Ave '54!�b
City/State/Zip:
Phone #:
Email
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? El Yes 0 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:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
GENERAL CONTRACTOR: (if different from applicant)
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eneral e8intrictor: 1\�J N h3 C' �,(A_6�MK P�Al bt:�,—
Mailing Address--e?W?f( !Fffy( Avc ou
City/State/Zi p: -F
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72
Phone #: _', C
E-mail: k; 0.. /a) f4e_�Ma_,"t AA
STATE UBI #: 609 '(79, -;- 6;;t,
CITY OF EDMONDS BUSINESS LICENSE Mukcl,26675
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
M i _rk R') 9 lip
TYPE OF PERMIT (Provide Details on Page 2)
El Accessory Structure/ 0 Addition
Detached Garage
El Demolition
0 Mechanical
El New Single Family/ Duplex
W rumbing
El Fire Sprinkler
F-1 Remodel
• New Commercial/ Mixed Use
0 Re -Roof
• Signs
El Tank
El Tenant Improvement
El 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:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished 0 Unfinished 0
Ist Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
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hie —
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: fi'4 /Jo "/a-
Signatu Date
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load (s):
Type(s) of Construction:
Fire Sprinklers: Yes El No El
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 /Compre isor
Air Handier /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercia 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 - Tar kless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs Qty 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)
MY
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:
Study Required 11 Conditional Waiver El Waiver El
Fill in Place El Fill Material:
Removal 1:1
Size of Tank (Gallons)
Critical Areas Determination:
Study Required El Conditional Waiver El Waiver El
GRADE/FILL/EXCAVATE
Grading: Cut - cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No 0
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.
CITY OF EDMONDS
121 5TH AV2,TUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
/17c. IS"'�
STATUS: ISSUED 09/05/2019 Permit#: BLD20191120
ExpirationDate: 03/03/2020
Parcel No: 27032500306200
SUNRISE SENIOR LIVING
C/O SUN I EDMONDS WA LLC HCP
223 5 FARADAY AVE STE 0
CARLSBAD, CA 92009
Project Address: 750 EDMONDS WAY, EDMONDS
MINNIS CUSTOM PLUMBING MINNIS CUSTOM PLUMBING
24311 54TH AVE W 24311 54TH AVE W
MT LAKE TERRACE, WA 98043 MT LAKE TERRACE, WA 98043
LICEN SE #: MINNIT RI 0 1 DA EXP:09/18/2019
SET ONE SINK FOR T/1, ALSO ADDING IN R/I FOR COFFEE MAKER BLD2019-0217
VALUATION: $0
PERMIT TYPE: Commercial
PERMIT GROUP: 47 - Plumbing
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE:
JOTHER: ------- OTHER DESC:
ZONE:
INUMBER OF STORIES: 0
VESTED DATE:
INUMBER OF DWELLING UNIT S: 0
ILOT #:
EXISTLNG AREA
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
PRO PO S ED ARLA
[BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
IBEDROOMS: 0 BATHROOMS: 0
FRONT S ErBACK SIDESEFBACK REAR S ErBACK
�EQUIRED: PROPOSED: IREQUIRED: PROPOSED: IREQUIRED: PROPOSED:
iEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
'ETBACK NOTE :
5 S
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZEDTHERZEBY, 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.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING Off!�R HISIHE14ag4pY AND ALL FEES ARE PAID.
4 M e7 =,5
Sigoa*e -Print Narne' I Date Released By Da(e
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/ IBC1 10/ IRCI 10.
= FIRE = APPLICANT = ASSESSOR /�n CITY
STATUS: ISSUED BLD20191120
CONDITIONS
• Final approval on a project or final occupancy approval must be granted by the Budding Official prior to use or occupancy of
the building or structure. Cbeck the job card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") fi7om
adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
• Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been
specifically identified, requestedand considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
• Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fi7omthe noise limits
of ECC Cbapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and 10:00amand 6:00pm on Saturdays, excluding
Sundays and Federall1olidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
ham-Aess the City of Edmonds, Washington, its officials, errployees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance for this permit. Issuance of this pennit shall not be deenied to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance
provision.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDIEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT
TIME LIMIT. SEE ECDC 19.00.005(A)(6)
I TO SCHEDULE INSPECTIONS
BUILDING
1. Go to: www.edmondswa.gov
2. Then: Ser\4ces
3. Then: Perm its/Development
4. Then: Online Permit Info
5: If you don't haw one already, create a
login (upper right hand comer)
,6: Schedule your inspectio
Building Department Inspections
are now scheduled online. If you
ha\e difficulties, please call the
Building Department front desk for
,assistance during office hours.
(425) 771-0220
i ENGINEERING (425) 771-0220 EXT. 1326 1
FIRE (425) 775-7720
PUBLIC WORKS (425) 771-0235
RECYCLING (425) 275-4801
When calling for an inspection please lea\e the following information: Permit Number, Job Site Address, Type of Inspection
being requested, Contact Name and Phone Number, Date Preferred, and whether vou Prefer mominq or afternoon.
• B-Plumb Rough In
• B-Plumbing Final
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