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Building_Permit_Permit_Application_2019_8122-fence-install.pdfTYPE OF PERMIT (Provide Details on Page 2) □ Accessory Structure/ Detached Garage □ Addition □ Demolition □Mechanical □New Single Family / Duplex □ Plumbing □ Fire Sprinkler □ Remodel □New Commercial/ Mixed Use □ Re-Roof □ Signs □ Tank □ Tenant Improvement X□ OtherFence _______________ 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 indicatedon this application. Valuation: __________________________________ PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished □ Unfinished □ 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport:,sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT DESCRIPTION 8x6 cedar panel fence on east and west property lines from existing fence line to edge of 206thSW street lot line; 3 foot high cedar fence on north property line (along 206thst SW) _________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ 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: Shahbaz Yusuf _________________________________________ Signature: ___________________________ Date __4/21/2020________ JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: _8122 206thst SW_____________________________________ Parcel: ______________________________________________ Lot /Unit/Suite #: _________ Subdivision: __________________ PROPERTY OWNER: Name: __Shahbaz Yusuf____________________________________________ Mailing Address: __8122 206thst SW____________________________________ City/State/Zip: _98026 _______________________________________ Phone #___425-681-8463 _________________________________________ Email: __shahbazyusuf@msn.com_____________________________________________ OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? XYes 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: ______Shahbaz Yusuf_ APPLICANT / CONTACT INFORMATION: Name of Applicant: __Shahbaz Yusuf__________________________________ Mailing Address: _____8122 206thst SW_________________________________ City/State/Zip: ____Edmonds 98026 ____________________________________ Phone #: 425-681-8463 ________ E-mail: shahbazyusuf@msn.com GENERAL CONTRACTOR: (If different from applicant) General Contractor: ____________________________________ Mailing Address: _______________________________________ City/State/Zip: ________________________________________ Phone #: _____________________________________________ E-mail: ______________________________________________ STATE UBI #: _________________________________________ CITY OF EDMONDS BUSINESS LICENSE #: __________________ WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: ____________________________________________________ BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 Office Use Only Permit #: 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 professional, 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! GENERAL COMMERCIAL DATA GAS/FUEL CONNECTION COUNTS (New, Relocated or re-piped) Occupancy Group(s): Occupant Load(s): BTUs Qty BTUs Qty A/C Unit Outdoor BBQ / Fire pit Type(s) of Construction: Fire Sprinklers: Yes □ No □ Boiler Stove/Range/Oven WA STATE ENERGY CODE: If your project affects the building envelope, mechanical systems, and/or lighting, you must complete the appropriate WSEC forms. Dryer Water Heater DEFERRED SUBMITTALS: All commercial building permits that will require associated plumbing, mechanical, fire sprinkler, and/or fire alarm permits are applied for separately. Fireplace/ Insert Other: Furnace Other: TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet MECHANICAL EQUIPMENT COUNTS (New and Relocated) MEDICAL GAS, AIR VACUUM COUNTS (New, Relocated or re-piped) BTUs Gas / Elec / Other Qty Qty Qty Carbon Dioxide Nitrous Oxide A/C Unit /Compressor Helium Oxygen Air Handler /VAV Medical Air Other: Boiler Medical - Surgical Vacuum Other: Dryer Duct DEMOLITION Exhaust Fans Type of structure to be demolished: Fireplace Square footage of structure to be demolished: Furnace AHERA Survey done? Y / N PSCAA Case #: Heat Pump Unit Critical Areas Determination: Study Required □ Conditional Waiver □ Waiver □ Hydronic Heating Roof Top Unit (Provide elevations if a Commercial Bldg) TANK Fill in Place □ Fill Material: _______________ Other: Removal □ Size of Tank (Gallons) ___________ PLUMBING FIXTURE COUNTS (New, Relocated or re-piped) Critical Areas Determination: Study Required □ Conditional Waiver □ Waiver □ Qty Qty GRADE/FILL/EXCAVATE Clothes Washer Tub/ Showers Grading: Cut ______________ cubic yards Dishwasher Backflow Device (RPBA, DCDA, AVB) Fill ________________ cubic yards Drinking Fountain Pressure Reduction/ Regulator Valve Cut / Fill in Critical Area: Yes □ No □ Floor Drain/Sink Refrigerator Water Supply GENERAL PROVISIONS Hose Bibs Water Heater - Tankless? Y or N APPLICATIONS: Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. Hydronic Heat Water Service Line 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. Sinks Other: Toilets Other: