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image2020-01-13-084445'4c.. l?'4V BUILDING PERMIT APPLICATION Devefo menf Services P Building Division 21 Sth Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: www.edmondswa.aov. 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 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 caH 425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work Is taking place) Job Site Address: 2.11(y) F501 f 1 W Parcel: cxi3-73�t'rJS�(%r� Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: 1 Name: _�rfGU'l ��eC�411LG/� I_ Mailing Address: i City/State/Zip: 8CA)!n°41jdS i _1 Phone #: �� ~ c lot 1 Email: _ OWNER INSTALLATION: *If yes, read and sign" Will work be performed by the property owner? ❑ YesD&Vo 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: _6('&_QWXd 44�41nY A AL Mailing Address: _ S 9 G(AQU St City/State/Zip: W Fir a k 13L4 _ Phone#: � -E�) ZCS�— [&L ' E-mail: QOWLLITA, . CGVY1 GENERAL CONTRACTOR: (if different from applicant) General Contractor: n r f I tLtt Mailing Address: City/State/Zip: Phone #: E-mail: i , rr�� STATE UBI M _LOC 2 � —I CITY OF EDMONDS BUSINESS LICENSE M _N_K-6,! LG 42,-1 WA STATE CONTRACTOR L & I If: (CCB) & EXPIRATION DATE: TYPE OF PERMIT (Provide .- ❑ Accessory Structure/ ❑ Addition Detached Garage ❑ Demolition Mechanical © New Single Family/ Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel 0 New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs O Tank rOTenant 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: PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished ❑ Unfinished EJ 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT• ] i 1 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: 4q,t. u-� Signature: Date 1 3 26W I.. GENERAL. DATA Occupancy Group(s). Occupant Load(s): Types) of Construction: Fire Sprinklers: Yes ❑ No O 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 COUNTSMECHANICAL EQUIPMENT BTUs Gas / Elec / Other Qty A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct Exhaust Fans Fireplace Furnace Inv Gras Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE . • or .. 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: CONNECTION •Relocated or re -piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ J Fire pit Bailer Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: MEDICAL/ Relocated or re -piped) Qty Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: 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 ❑ Conditional Waiver 0 Waiver O Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required O Conditional Waiver O Waiver O ••. Grading: Cut cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ No O GENERAL•/ • APPLICATIONS: Applications are valid for a maximum of 1 year. ESL HA 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.