3030_001.pdf0 V- E b4f
CITY OF EDMONDS
1215THAV0,RJENORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
/lie isl)%�
STATUS: ISSUED 12/02/2019 Ile rinif fl: B LD2101 9153 1,
IWILDING 11'1,-�RM IT
Expiration Date: 06/02/2020 Project Address: 22315 HIG 11WAY 99 #i, ED M ON DS
Parcel No: 27042900302700
CAPITAL EQUITY FUND III
CIO TED YAMAMURA
PO BOX 9445
SEATTLE, WA 98119
(206) 321-0415
REID CONSOLIDATED SERVICES INC REID CONSOLIDATED SERVICES INC
2322 NW 197TH ST 2322 NW 197TH ST
SHORELINE, WA 98177 SHORELINE, WA 98177
(209) 941-2300
REPLACE BATHROOM FAN THAT TENANT REMOVED
VALUATION: $0
(209) 941-2300
LICENSE #: EXP
PERMIT TYPE: Commercial
PERMIT GROUP: 40 - Mechanical
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION
RETAININGWALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: OXO FT)
CODE:
JOTHER: ------- OTHER DESC:
IZONE:
NUMBER OF ST RIES: 0
VESTED DATE:
NUMBER OF DWELLING UNIT S: 0
LOT
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
BEDROOMS: 0 BATHROOMS: 0
FIU)NTS FFBACK SIDFISI—FBACK 11 E A R S VFH AC K
REQUIRED: PROPOSED: IREQUIRED: PROPOSED: I REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:0 IREQUIRED: PROPOSED:
SETBACKNOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
PERSONWILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPENSATION
INSURANCE AND RCW 18:27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIA�4 HISMER QEBJJY AND ALL FEES ARE PAID.
�) 9 r(,i -f - A Y,) 012 /2 01� � 'e L)=� �� e
Signature Print Name Datd Released By L)SIQ
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING ORSTRUCIURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10/ IRC110.
FIRE APPLICANT ASSESSOR cny
STATUS: ISSUED BLD20191531
• Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check 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") from
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, requested and 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.
SoundNoise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. 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 indernnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this pennit shall not be deemed 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 THEWORK NOTED. THIS PERM[TCOVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT
TIME LIMIT: SEE ECDC 19.00.005(A)(6)
BUILDING
1. Go to: www.edmondswa.gov
2. Then: SeNces
3. Then: Permits/Development
4. Then: Online Permit Info
5: If you don't have one already, create a
login (upper right hand comer)
6: Schedule vour insDection
Building Department Inspections
are now scheduled online. If you
have difficulties, please call the
Building Department front desk for
assistance during office hours.
(425) 771-0220
ENGI NEEM NG (425) 771-0220 EXT. 1326
FIRE (426) 776-7720
PUBLIC WORKS (425) 771-0235
RECYCLING (426) 275-UOI
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
being requested, Contact Name and Phone Number, Date Preferred. and whether YOU prefer morning or afternoon.
. B-Mechanical Final
I11c. W)v
BUILDING PERMIT
APPLICATION
Development Service.,
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.Pov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, Lorge 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)
-2- �Jvv� 1% 6 #
Job Site Address: 4
Parcel:
Lot Unit/Suite#: Subdivision:
PROPERTY OWNER:
N a rn e: Cc,�) I i 6\ I �q till �U.��
Mailing Addr'ess: 00 (CAV� lok'C"Ilk u i0
City/State/Zip: PQ k;, q qq y , 5�ck q
Phone#: 3-06- 321 - 0q 11�__
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? 0 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: 1'61J4
Mailing Address: 33)_ 1 If L
City/State/Zip: , 5�() re J,A( �VA 907 7
Phone #:
E-mail: 0 C11 (If r r Co Yn
GENERAL CONTRACTOR: (if different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 60:� 2LI/6-18'
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB�&,EXPIPATION DATE:
/10.2
rmit #: 2-0
TYPE OF PERMIT (Provide Details on Page 2)
0 Accessory Structure/ El Addition
Detached Garage
El Demolition
El Mechanical
0 New Single Family/ Duplex
0 Plumbing
El Fire Sprinkler
El Remodel
El New Commercial/ Mixed Use
El Re -Roof
0 Signs
El Tank
El Tenant Improvement
1:1 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 El Unfinished L1
1st Floor, sq ft:
2nd Floor, scift:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Cthersq ft:
PROJECT DESCRIPTION
Te I (,-,v% � fe"A 6C.4,0d M
V\ weeki o,�o, i /i oc, I c
fan
VIC UV uv�le' 010 L"/C"y
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. I
Print Name:
Signature- Date
GENERAL COMMERCIAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction:
Fire Sprinklers: Yes 0 No 0
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 /Compressor
Air Handier /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
PLUM13ING 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 - Tankless? 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:
I
Furnace I Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re -piped)
Qty Qty
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgic
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 El Conditional Waiver 0 Waiver El
Fill in Place El Fill Material:
Removal Size of Tank (Gallons)
Critical Areas Determination:
Study Required El Conditional Waiver El Waiver D
GRAD E/FI LL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No El
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of I 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.