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BLD2020-0537_City_Application_5.26.2020_8.58.39_PM''le. I s9 BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements go to: www.edmondswo.aov. To apply for permits, schedule inspections, or check application status go to. www.mybuildinapermit.com JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 81/0 Marty 5 of f T Parcel: C O'10 SG 0050 f cl oL Lot /Unit/Suite #: Subdivision: BUSINESS OR PROPERTY OWNER: Name: F Rsx->Grt t�Ny_,.«t_IAF{eRA-L Gcyrfe_ Mailing Address: 6 `101 m ,,z "' S rR E e r City/State/Zip: A,' A Phone#: CNZS) G97- ZZ7ZZ Email: G�f�IkFi=L+s@.1/CSCSEarrLE,CJr� OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? Dyes F-1 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: �ZLrT[R PL�w3L►.�Ci�Y�tulrwr«�- Mailing Address: 212 o0 2-72,j0 AvE SCE Jtt- 13 2 9 City/State/Zip: FZ,�.VewSbAI-E, VJN Q0051 Phone #: (206) 76gi - boy I y E-mail: TACor36)P-LrrcgPCwA-E jct/w,k)►.nCC4' r(41- C01-\ GENERAL CONTRACTOR: (If different from applicant) General Contractor: AL- e, C14-4-&sSc( Mailing Address: tji 0 240r74 57 SE City/State/Zip: g o r«1 CLL , WA 96 oz i Phone #: E-mail: P1 MIl, NLC2 i�h�b,elW-ASSoC. CO�"1 STATE UBIM 195 CITY OF EDMONDS BUSINESS LICENSE M WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: RITT�� M S y 3 D i C`fice use C^ly TYPE OF Accessory Structure/ Detached Garage Details on Page Addition Demolition Mechanical New Single Family/Duplex Plumbing Fire Sprinkler Remodel New Commercial/Mixed Use Re -Roof Signs ❑ Tank © Tenant Improvement ❑ 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: * 55, 000 , PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished ElUnfinished❑ 1st Floor, sq ft: 2nd Floor, sqft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: # of NEW Bedrooms: # of NEW Bathrooms: PROJECT• �Ld��fSiv(� UG r—Y- 4A-'EA StiJ Rni r)crsTt tjC VETE a-i kyA�AlJ DrF-FCE 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. J n_ Print Name: Signature: Date LLS 25 2 0 GENERAL COMMERCIAL DATA Occupancy GrouO. (s)*: Occupant Load.(s), Type(s).of.Construction: Fite Sprinklers*.- Yes EIN611 WASTATE., E * NERGY CODE: If your project.affectsthe.buildlIng.envelope, mechanical systems, and/or lighting, you must.completethe. appropriate WSEC:forms. DEFERRED. SUBMITTALS: All commercial building permits: that will requi* ire associated.plumbing, mechanical, fire splirinkler'a nd/or fi re alatm permits are applied for - separately. 71 CHANGE OF USE /NEW BLDG:* Include TRAFFIC IMPACT wo rksheet F_ ! MECHANICAL EQUIPMENT COUNTS (New and Relocated) BTUs Gas Elec /* Other-* QtY .A/C Unit/Compressor Air Handier /VAV Boller Dryer Duct. Exhaust Fans Fireplace Furnace HeatPump-Unh 14.ycleonic.ftatirig RopfTop Unit (Provide ej.eO- dons if acom rneriial Bldg) PLUMBING FIXTURE COUNTS (New,'Relocated or -re piped) qty Qty ClothesWasher* Tub/Sh6wers Dishwasher. Rackflow Device (RPBA, DCDA, AVB) Drinking. Fountain Press - u ee Reduction/ Regulator Valve. -Floor Drain Sink Refrigerator Waiter Supply Hose Bibs Water Heater-- Tankless? Yor.N Hydtonic-Heat Water Service -Line Sinks Other: Toilets: Other: GAS/FUEL CONNECTION COUNTS BTUs Qty (New, Relocated or re piped) -BTUs Qiy A/C Unit. Outdoor BBQ /.Fire pit Boiler Stov6/Range/Oveh Drye r** Water Heater Fireplace/ Insert Other Furnace Other: M EDICAL GAS, Al R VACUU M COU NTS (New,iRelocked or -re piped). QLY QtY Carbon. Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: m6xi) Medical - Surgical Vacuum !r: DEMOLITION Type of stru;turetote..dernolished: Square footage .of structure to be die.rnolished: .AHFRA.:Survey -done? Y[]/ N[] P$CAA -Case M Critical Areas Determination: Study Required ❑ Conditional: Waiv*erE3 WaiverD -Fill in Place F-1 Fill Material: Removal.[] Size- of Tank. (Gallons) Critical Areas Determination: 'Study Requited Conditional Waiver Waiver* GRADE/FILL/EXCAVATE .Gr.ddihg:-Cut. pubic.yards Fill cubic -yards Cut Fill in Chtical Area: Yes ❑ No ❑ GENERAL PROVISIONS APPLICATIONS: Applications are valid for. a maximum of I year. ESI-HXApplicationsi 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 Licebse.