2264_001.pdfc. l8
BUI¡.DING PERMIT
APPTICAT¡ON
Developmenl Seryices
Building Division
l21 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.ed m ondswa.gov.
PLEASE NOTE: lntake appointments are required for New Single Family
Residences, lorge Additions, ADU's, New Commercial, and Major Tenant
lmprovement application submittals. lf 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.
Plesse call 425-777-0220 to schedule an intake appointment!
Permil #
tr Addition
[] Mechanical
ffimbins
tr Remodel
tr AccessoryStructure/
Detached Garage
tr Demolition
tr New Single Family / Duplex
tr Fire Sprinkler
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)tr New Commercial/ Mixed Use ! Re-Roof
Job Site Address:n Signs ! Tank
Parcet: A?O 3â. 1re @ qo()zôo
E Tenant lmprovement tr Other
Lot /U Subdivision
PROPERTY OWNER:Qfo 5'.-¡r;
ht v) p"o ' EÅMù,k w
Remodel Permil fees ore bqsed on:
The volue of the work performed. lndicole the volue (rounded to
the neoresl dollor) of oll equipment, moteriols, lobor. overheod,
ond the profit for the work indicqted on this opplicotion.
n" ",4h-ñA\c <- 4 a
Mailing Address:e
Voluqlion:
City/State/Zipr
Phone #:
Email Basement sq ft:Finished E Unfinished E
OWNER INSTALLATTON: *lf 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
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
78.27.094.
Owner Signature:Deck/Covered Porch/Patio:
APPUCANT / CONTACT TNFORMATTON:Other sq ft:
Name of Applicant:
Mailing Address:f c
City/State/Zip:ll
Phone #:
E-mail:L:xp-
GENERAT CONTRACTOR: (lf different from applicant)
8åg[F.m,Z.tor: l','.ì NNä 5 ( r,.'s{l^ Ptilbu-
¿,",,.244 ft Ç+tl Avc f
Mailing Ad hJ
City/State/Zip:
Phone #:D^
E-mail
I certify that the information I have provided on th¡s form/application ¡s true,
correct and complete, and thãt I am the property owner or duly authorized
agent of the property owner to submit a perm¡t appl¡cation to the City ofsrArE uBr *z b?.r( 7,* I 6A
þÈoasøs_Edmonds.
CITY OF EDMONDS BUSINESS LICENSE $:
WA STATE CONTRACTOR [ & If: (CCB) & EXPIRATION DATE:
t v
Print Name:
o.t 1*5-17
IYPE OF PERMIï (Provide Detoils on PcEe 2)
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
PROJECT DESCRIPTION
Toilets
Sinks
Hydronic Heat
Hose Bibs
Floor Drain/Sink
Drinking Fountain
Dishwasher
Clothes Washer
Other:
Roof Top Unit (Pro'ride eleva-
tions if a Commercial Bldg)
Hydronic Heating
Heat Pump Unit
Furnace
Fireplace
Exhaust Fans
Dryer Duct
Boiler
Air Handler /VAV
A/C Unit /Cornpressor
Type(s) of Construction
Occupancy Groupris)
Other:
Other:
Water Service Line
Water Heater - Tarrkless? Y or N
Refrigerator Water Supply
Pressure Reduction/ Regulator Valve
Backflow Dev¡ce (RPBA, DCDA, AVB)
Tub/ Showers
ary atv
BTUs Gal; / Elec / Other Qty
Tl / CHANCE OF USE / NEW BLDG: lnclude TRAFFIC IMPACT worksheet
DEFERRED SUBMI-|-TALS: All commercial building permits that will require
assoc¡ãted plurnbing mechanical, fire sprinlller, and/or fire alarm
perm¡ts are applied for separately.
WA STATE ENERG'/ CODE: lf your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
Fire Sprirrklers: Yes ! No !
Occupant Load(s):
GENERAL COMMERCIAL DATA
MECHANICAT EQUIPMENT COUNTS (lNew and Relocated)
PLUMBING FIXTURE COUNTS (New, Relocated or re-piped)
Furnace
Fireplace/ lnsert
-Dryer
Boiler
A/C Unit
Medical - Surgical Vacuum
Medical Air
Helium
Carbon Dioxide
Removal E
AHERA Surveydone? Y/N
Other:
Other:
Water Heater
Stove/Range/Oven
Outdoor BBQ/ Fire pit
Other:
Other:
Oxygen
Nitrous Oxide
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & lndustries and have a
current CiÇ of Edmonds Business L¡cense.
APPLICATIONS: Applications are valid for a maximum of l year
ESLHA Applications, 2 years.
Cut / Fill in Critical Area: Yes ! No E
cubic yardsF¡II
Grading: Cut cubic yards
Critical Areas Determination:
Study Required D Conditional Waiver D Waiver E
Size of Tank (Gallons) _
Fill in Place E Fill Material:
Critical Areas Determination:
Study Required E Conditional Waiver ! Waiver E
PSCM Case #:
Square footage of structure to be demolished:
Type of structure to be demolished:
Qtv Qtv
BTUS aty BTUS Qty
GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped)
MEDICAL
(New
GAS, AIR VACUUM COUNTS
, Relocated or re-piped)
DEMOLITION
TANK
GRADE/FI LL/EXCAVATE
GENERAL PROVISIONS
CITY OF EDMONIDS
I2I 5TH A\iENTIENORTH - EDMONDS, WA 98020
PHONE: (42s)171-0220 - FAX: (42s)771-022r¿c. l8
STATUS: ISSUED 0910512019 Permit#: BLD20l9ll20
BLIILDING PERMTT
ExpirationDate: 0310312020 Prcject
P arcel No: 27032500306200
Address: 750 ED ONDS \ryAY, E DMONDS
PROPRTYOWNR.CONTRACTORAPPLICANT
SUNRISE SENIOR LIVING
CiO SUNI EDMONDSWA LLC HCP
2235 FARADAY AVE STE O
CARLSBAD, CA, 92009
MINNIS CUSTOM PLUMBING
24311 54THAVEW
MT LAKE TERRACE, V/A 98043
MINNIS CUSTOM PLUMBING
24311 54THAVEW
MT LAKE TERRACE, WA 98043
LICENSE#:MINNITRI0lDA EXP:09/1812019
JOB DESCRIPTION
SET ONE SINK FOR T/I, AI.SO ADDING IN R/I FOR COFFEE MAKER BII.2OI9-0217
VALUATION: $0
Name Date
ATTENTIO¡{
Released By
ITIS UNLA'WFUL TO USE OROCCUPY A BUILDINC ORSTRUCruREUNTIL A FINAL INSPECTON HAS BEEN MADE AND APPROVAL ORA CERTtrICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCl09/ IBCI 1O/ IRC1 IO.
PERMIT GROUP:47 - Pliunbing
TYPE OF CONSTRUCTION
OCCUPANT GROUP
OCCUPANT LOAD
CODE:
ZONE:
\IESTED DATE
2ND FLOOR:0IST FLOOR:0
LOT #
BASEMENT: O
DECK:0 OTHER:03RD FLOOR:0 GARAGE:0
BEDROOMS:0 BATHROOMS:0
PERMIT TYPE: Commercial
CYDS: OGRADING: N
RETAININGWALL ROCKERY
FENCE: l0X0 FT.l
OTHER: ------ OTHER DESC:
NUMBER OF STORIES: O
NUMBER OF DWELLINGLINITS: O
2ND FLOOR:0IST FLOOR:0BASEMENT: O
3RD FLOOR:0 GARAGE:0 DECK:0 OTHER:0
BEDROOMS:0 BATHROOMS:0
PRO PO S ED AR["AD(ISTING ,\R[A
REQUIRED: PROPOSEDREQUIRED: PROPOSED:
REOUIRED: PROPOSED:
REQUIRED: PROPOSED:
HEIGHT ALLOWED:0 PROPOSED:O
SETBACK NOTES:
RE{R SETBACKSIDESE-IBACKFRONT SE-TBACK
Novotc q?-ç^
IAGREETO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THEWORK AUTHORIZEDTHEREBY, NO
PERSON WILL BE EMH-OYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATNG TO WORKMEN'S COMFEA.ISATION
INSURANCEAND RCW l8:27.
IS NOT A FERMIT UNTIL SIGNED BY THE BUILDINGTHIS AFF-ICA AND ALL FEES ARE PAID.
PERMIT APPROVAL
FIRE APPLICANT ASSBSOR CITY
CONDITIONS
STATUS: ISSTIED BLD2019 tr20
Final approval on a project or fina.l occupancy approval rn¡st be granted by the Building Official prior to use or occupancy of
the building or structurç. Check the job card for all required City inspections including final project approval and final
occupancy inspections.
Any request for altemate design, nndification, vaiance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances orpolicies r¡nrst be specifically requested in writing and be called out and identified. Processing
fees for such request shallbe established by Council and shall be paid upon submittaland are non-refundable.
Approval of any þlat or plan containing provisions which do not corrply with city code and for which a variance has not been
specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision
of city code or state Iaw does not approve any iterrs not to code specification.
Sound,l.{oise originating fromtenporary construction sites as a result of construction activity are exenpt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:{Damto 6:00pmon weekdays and 10:00amand 6:00pmon Saturdays, e><cluding
Sundays and Federal Holidays. At all other tirrps the nois e originating from construction sites/activities mrst conply with the
noise limits of Ctrapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
Applicant, on behalf ofhis orher spouse, heirs, assigns, and successors in interests, agrees to inderrnifo defend and hold
harrnless the City of Edrrnnds, Washington, its officials, enployees, and agents from any and all clains for dannges of
whatevernature, arising directly orindirectly fromthe issuance forthis permit. Issuance ofthis permit shallnot be deer¡rd to
nþdify, waive or reduce any requ:irenrents of any City ordinance nor Limit ìn any way the City's ability to enforce any ordinance
provision.
THIS FERMIÏ AUTHORIZ ES ONLY THE WORK NOTED. THIS PERMII COVERS WORK TO BE DONE ON FRMATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CLIRBS, SIDEWALKS, DRMEWAYS, NTARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. FERMTT
TIME LMn: SEE ECDC 19.00.005(AX6)
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INSPECTIONS
TO SCHU)ULE INSPECTIONS
1. Go to: www.edmondswa.gov
2. Then: Services
3. Then: Permits/Dewlopment
4. Then: Online Permit lnfo
5: lf you dont hale one already, create a
login (upper right hand comer)
6: Schedule vour inspection
BUILDING
Building Department lnspections
are now scheduled online. lf you
have diffculties, please call the
Building Department front desk for
assistance during ofice hourc.
(425)771-0220
FIRE (425) 775-7720
PUBLTC WORKS (4251 77 14.235
RECYCLT NG (4251 27 54801
ENGTNEERTNG (425) 771{.220 Ð(T. 1326
When calling for an inspection please leale the following information: Permit Number, Job Site Address, Type of lnspection
being requested, Contact Name and Phone Number, Date Prefened, and whether you prefer morninq or aftemoon.
BPlumb Rough In
BPlumbing Final
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