20200129121008BUILDING PERMIT
APPLICATION I Permit #:
Develonment Services
Building Division TYPE OF PERI
121 Sth Ave N / Edmonds, WA 98020 �
425.771.0220 1 0 Accessory Structure/
For handouts, Submittal requirements permit starus-and inspection
scheduling information go to: www.e�mondswa.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 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 appointmentl
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
JobSiteAddress:
Parcel:
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name:
Mailing Address.
City/State/Zip: P_t-11y11A'NC1S i,��
Phone #: c)C,� - 61
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? 0 Yes,:�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; -G+,Ii
MailingAddress:
City/State/Zip: E%i-eve-kj P� -I h) o I
Phone '7_!��, C1 - 0':7>'_->0
E-mail: 1--c ^ re-) L v-rN \-Nr r,-A . v,,-, . (
GENERAL CONTRACTOR: (If different from appiTcant)
General Contractor:- C \Arr,,-*,y\rA
. J
MailingAddress: A
City/State/Zip: F_V-f,t4�
Phone #: �A'1,5 ODS
DC)
E-ma 11: f P c, ify-N " -e rA C L>Nv
STATEUBIM
CITY OF EDMONDS BUSINESS LICENSEM
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Q m\-vp P� t-A \A �) -v_\ -N, -, I -) L-),-.) I
0 Demolition 1 '01 Mechanical
El New Single Family/ Duplex I OPlumbing
0 Fire Sprinkler 1 0 Remodel
0 New Commercial/ Mixed Use 1 0 Re -Roof
0 Signs 1 0 Tank
0 Tenant 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 profit for the work indicated on this application.
Valuation:
Basement sq ft: Finished 0 Unfinished 13
Ist Floor, sq ft:
2nd Floor, sqft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
\ Y) e;-Vc, CA --"V-�rx I C, P
d k_x
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: ).aItn'P e- "I) ) ete^
Signature: 6:��ate
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes El No El
WA STATE ENERGY CODE: If your project affects the building envelope,
—mechaniLdi system"rid/orttghting, Vou—must-mmPtet-e-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
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
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:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/ Ra nge/Ove n
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other: L
MEDICAL GAS, AIR VACUUM COUNTS
(New, 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 1:1 Conditional Waiver 0 Waiver El
Fill in Place El Fill Material:
Removal El
I Size of Tank (Gallons)
Critical Areas Determination:
Study Required 0 Conditional Waiver El Waiver El
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes El No El
GENERAL PROVISIONS
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA 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.
, j -2�qo�o (� "Wok pkace Wes_�
MUZHM18NA
Com, pressor Locked Rotor Amps
Compressor Rated Load Amps
CompressorType
Cooling Capacity
Cooling Temperature
Defrost Method
EER
Electrical Rating
External Finish Color
Fan Motor Full Load Amperage
Fan Motor Output
Gas Pipe Size
Heating Capacity
Heating Temperature
9.3A
FV50S // 11.8 oz.
7AA
DC INVERTER -Driven Twin Rotary
17200 Btu/h
115/14
Reverse Cycle
10.5
208/23OV, 1 phase, 6OHz
Munsell 3Y 7.811/1
0. 5A
55W
1/2" O.D. (Flared)
18000 Btu/h
75/4
7-L--�C)Qo 012c;,ick �--Ac�,ce U,30— (,� -�
Maximum Piping Length
MCA
Package Dimensions
Package Weight
Refrigerant
Refrigerant Charge
Refrigerant Control
37" W x 14-15/16" D x 24-13/16" H
2 lbs, 10 oz.
LEV
Seer
18.0
Sound Rating (Cooling)
50 dB(A)
51 dB(A)
Sound Rating (Heat)
Type of Heat Exchanger
Plate Fin Coil
Unit Dimensions
31-1/4" W x 11-1116" D x 21-5/10" H
ck,� , c k q\cx-c e �',-A-
Unit Weight
81 lbs
187 - 253 VAC