3471_001"'c' lsll�'
BUILDING PERMIT
APPLICATION
Development Services
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, 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 call 425-771-0220 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION: (where the work is taking place)
Job Site Address: (4
Parcel:
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name:
MailingAddress:
City/State/Zip:
Phone #:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? L1 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: ZL14�
V
MailingAddress: C7;>,31�_) 4 "IV/
City/State/Zip:
Phone #:
>
E-mail:
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 CONT:RACTOR L & I #: (C�B) & EXPIRATION DATE:
i2 )L
C-, C2-_ 2--S V �2
rmit #:
TYPE OF PERMIT (Provide Details on Page 2)
0 Accessory Structure/ 0 Addition
Detached Garage
El Demolition
-WMechanical
0 New Single Family/ Duplex
El Plumbing
El Fire Sprinkler
0 Remodel
0 New Commercial/ Mixed Use
El Re -Roof
El Signs
El Tank
?Jenant Improvement
0 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 prof Vor the work indicated on this application.
ValuationR a.D -0
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished El Unfinished EI
1st Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Othersq ft:
PROJECT DESCRIPTION
A 4"71( 4-4
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:
*o"o
Signature:( - '/ I'A'IZZI Date
Type: PLUMBING Subtype: RESIDENTIAL PLUMBING Status: ISSUED
Parcel No: 00643700000200 Site Address: 8207 181ST PL SW EDMONDS,WA 98026-5420
Applied: 1/24/2020
Subdivision: 006437, 004343 Lot: 0
Issued: 1/24/2020 NED
Fire Sprinklers: Lot Area: Zoning:
Final:
Valuation: $0.00 Occupancy Type: Construction Type:
Expiration Date: 7/22/2020
NED
Code Edition: 0 No. Stories: 0 # of Dwelling Units: 0
WORK DESCRIPTION: GAS LINES TO 2 POOL HEATERS
CONTACTS
NAME TYPE NAME ADDRESS PHONE EMAIL
APPLICANT
PUGET SOUND GAS
, ANACORTES WA 98221-
(360)629-6082
PUGETSOUNDGASWORKS@GMAI
WORKS
3134
L.COM
CONTRACTOR
PUGET SOUND GAS
, ANACORTES WA 98221-
(360)629-6082
PUGETSOUNDGASWORKS@GMAI
WORKS
3134
L.COM
OWNER
DAMRON BRIAN &
8207 181ST PIL SW,
,HEATHER
EDMONDS WA98026-S420
Contractor License Information: WA State Contractor L& I #:PUGRTSG851N6 City of Edmonds Business License#: 602454996-001-
0001
FEE INFORMATION
DESCRIPTION ACCOUNT AMOUNT PAID PAID DATE RECEIPT #
1 - BASE FEE FOR PLUMBING
001.000.322.10.000.00
$50.00
$0.00
PERMITS
CITY TECHNOLOGY FEE
001.000.321.99.100.00
$40.00
$0.00
CHARGED PER PERMIT
I
I
I
CREDIT CARD TRANSACTION FEE
001.000.341.43.100.00
$3.60
$0.00
GAS PIPING - NEW OR LOCATED
001.000.322.10.000.00
$30.00
$0.00
TOTALS: $123.60 $0.00
CONDITIONS
CONDITION TYPE STATUS NOTES
Printed: Friday, January 24, 2020 11:51:07 AM 1 of 2