BLD20170672.pdfCITY OF EDMONDS
1215TH AVENUE NORTH - EDMONDS, WA98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 05/17/2017
Expiration Date: 11/17/2017
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Parcel No: 00488700200500
ELLEN A KEENE HOTLINE HEATING HOTLINE HEATING
24231 78TH PL W C/O GARY CLEAVE C/O GARY CLEAVE
EDMONDS, WA 98026' PO BOX 46232 PO BOX 46232
SEATTLE, WA 98146 SEATTLE, WA 98146
(941)447-4843: (206) 764-9276 (206)764-9276
LICENSE tk HOTLIH*844PU' EXP:11/02/2018
Move tub Ift from existing location. Replace 7 windows (2 bath, 4 bed, 1 entry) like for like.
VALUATION: $2,100.00
(PERMIT TYPE: Residential PERMIT GROUP: 43 - Miscellaneous
GRADING:N CYDSO TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: OCCUPANT GROUP
OCCUPANT LOAD
FENCE: { 0 X 0 FT.,) CODE:
OTHER: ------- OTHERDESC: ZONE:
NUMBER OF STORIES: 0 VESTED DATE:
NUMBER OF DWELLING UNITS: 0 LOT #;
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0, BASEMENT: 0 1 S 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:O BATHROOMS:O
REQUIRED: PROPOSED; REQUIRED: PROPOSED: REQUIRED: PROPOSED;
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE'WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27
111SA`lllAC TION IS RMITUNTIL;SIGNEDBYTHEBUILDINGOFFICIALORHIS/HERDEPUTYAND'ALLFEESAREPAID,
?rr�. C/%
Igoattlr ,` Print Name lath Released Bf Date
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: UBC] 09/ IBC110/ IRC110,
ONLINE APPLICANT ASSESSOR OTHER �"
V,
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
t 121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (S eet, Suite #, City State, Zip):
;�-L4 ;� 31 r7 Y �" P+— [,,-Jo
Parcel #:
F 8 �"7 d Sa t)
Subdivision/Lot #:
Project Valuation: $ C U
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APPLICANT:1 [ O.7 .i C L l 0� t—j` 7t o-� L t-
Phone: Fax:
a -o(, "764'qaIla
Address (Street, City, State, Zip):
E -Mail Address:
-e <� .oIi,nQ�;f►'►�a,
PROPERTY OWNER:
Q -VA fz tc, lin
Phone:
(Ko/ -L4grl -,Ll_ ?
Fax:
Address (Street, City, State, Zip):
E -Mail Address:
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONT CTOR:*
Phone: Fax:
ft1��i.f CUNT
Address (Street, City, State, Zip):
E -Mail Address:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
CC 4 1 L„,1 '
doing work in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
. c
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DETAILTHESCOPE OF WORK YV1 rsy.. _
`�' F�.>?...►=i2t�,L...w_w_K'STi�c,L.?(-m��rtrtii �
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t7) W 1 1J `1>Ow S
PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
Basement: t . ft.
Select Basement Type: Finished Ll Unfinished
I" Floor: sq. ft.
Garage/Carport: sq. ft.
2 Id Floor: _.._ __ sq. ft.
Deck/Cvrd Porch/Patio _...._s aft.
Bedrooms # Full -3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes No
Retaining Wall: Yes No
Grading: Cut „ cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes LJ NoLJ
I declare under penally of perjury laws that the information I have provided on this form/application is true, correct and
complete, and that I am the prope owner or duly authorized agent of the property owner to submit a permit application to
the th' o Edmonde.1
dt
�..
� t7�-r o�y�-4 t
Print Name: s'
Owner ❑ Agent/Other (specify): �/�/1i�}J
Signature: .mt. mm
Date: ..-..-..._..--��..�.
t.rr
FORINT A I--1BuMag New Felder 2010\DONE & x-fawd to LBuiung New driveWonn A2014AO" Vpd i 1i17i2014
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DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION FORM A
°S^
9"
12151h Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 It Fax 425.771.0221
Equipment Type
Appliance/Equipment Information (new and relo „ d)
Total #
Furnace
Gas #m
Elec # Other:— ----
—...—#� BTUs: <100k >tkNlk
Air Handler / VAV
Gas #
#
# CFM: <10k_ 11, o alio O,
(circle selected)
,Elec ,.m!Other:,
� .,
AC / Compressor /
Boiler / Heat Pump /
Gas #
Elec #_Other:__
.......... ....... __ # li 1"Us:... , .<100k, 100k-500k, 500k-1Mil
Roof ToUnit
P
HP:
c3, 3-15,
15-30 Locttion(s)--------
(circle selected)
Hydronic Heating
Gas #Elec
#_In-Floor
_Wall Radiattt 1111, Boiler BTUs Mar..,,,
Exhaust Fans (single
Bath #_m,_..
)
y flat r
Kitchen #l.aundr#
duct)
_ __-- - _ ........
Fireplace
Gas#
.....,Elec#_---thcr:_---
........ Loca'ttion(ti) .........
Dryer Duct
Appliance Type
Appliance/Equipment Information (new and relocated)
Total #
AC Unit
BTUs
Location(s):...... ......... 111_1
—
_
Furnace
BTUs: . 1111.
Location(s):
_._.
Water Heater
BTUs
..
Location(s): _
Boiler
BTUs:..
Location(s):
Other:
... .1.1.....11...1.......
BTUs:
....._a
Fireplace/Insert
.................mmmmmmmmmmmLocations)
TUs.1111
�.,. 6�m.
1,oca.t..ion(s ,', �
11B11 1111
1111 ......6�_............
............
Stove/Range/Oven
Dryer
Outdoor BBQ
TOTAL OUTLETS
Fixture Type (new and relocated)
i Total #
Fixture Type (new and relocated)
Total #
Water Closet (Toilet)
.....nkitchen,
Pressure Reduction Valve/Pressure Regulator
Sink ( undry, lavatory, bar, eye wash, etc.)
lan
Water Service Line
...... ....�_.
1111 1111 1111..
I
Tub/Shower
1 � �
Drinlong._.
Fountain
1111.., . .....................
Dishwasher .. _ .. _1111.. w
.........
_..-..-.-..-1111._
i..
Clothes Washe'...
Washer
......____.,,_----------
... _...
Hose Bib
............
............
Backflow Prevention Device (e g. xBPA, ocoA, AVB)
Water Heater Tankless? Yes ❑ No
Hydronic Heat in, Floor ❑ Wall0�
Floor Drain/Floor �.___........____
Sink
Other:
g or water supply (for water/ice dispenser)
Refrigerator
Other:
FORM A L:\Building New Folder 2010\DONE & x-ferred to L -Building -New drive\Form A2014.docx Updated: 1/17/2014