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HaaseMechApp.,c, lb - 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.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 call425-771-0220 to schedule an Intake appointmentl JOB SITE INFORMATION/LOCATION: (Where the work Is taking place) Job Site Address: Lncre� W--TIX Parcel: OCA tE& Lot /Unit/Suite It: Subdivision: PROPERTY OWNER: Name: =rye�(J?a t-"taa�� Mailing Address: !AX eA tau City/state/zip: r✓t�lmayr��,uJA 9 c�OZO Phone It: Email: OWNER INSTALLATION: *If yes, read and sign' Will work be performed by the property owner? ❑ 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: 1 I 1 Name of Applicant, —&( yt.P—v,% Mailing Address: City/State/Zip: �- �• ���� Phonell: d0k'0 E-mail: �Ou iYu-C a� CV\hA.h . GENERAL CONTRACTOR: (if different from `applicant) YYl General Contractor: BC�NN`CaY1 frlt�rl��1'iL1 Mailing Address: City/State/Zip:}'�P�n3A oirS�t,Qg Phone tt: U=e) 2ZAi�-1900 E-mail: STATE UBI M CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I It: (CCB) & EXPIRATION DATE: 3c'e�nl'1a9�I�9 �z/Z9/Z� TYPE OF PERMIT (Provide Details ❑ Accessory Structure/ ❑ Addition Detached Garage ❑ Demolition 21Mechanical ❑ New Single Famlly / Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑ Tank ❑ Tenant Improvement IN Other 'pw2ICel 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 N EW SQUARE FOOTAGE FOR T1 IIS APPLICATION Basement sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2nd Floor, sqft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT DESCRIPTION 0-Vkae tWoo a� . y)noces. L; we Fix 1;, Y e �anae C�)t. 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. I, Print Name-_ Signature: C�' ate GENERAL• DATA Occupancy Group(s): Occupant Load(s): Type(s) of Construction: Fire Sprinklers: Yes ❑ No ❑ 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 MECHANICAL• •Relocated) BTUs Gas Elec / Other City A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct Exhaust Fans Fireplace Furnace 1— c)• t pis• ") L Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions If a Commercial Bldg) Other: FIXTUREPLUMBING •Relocated. .. QtY City 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 COUNTS• or BTUs City BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: COUNTSMEDICAL GAS, AIR VACUUM .. ..•. City City _ 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 ❑ Waiver ❑ Fill In Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ .D Grading: Cut cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ No ❑ GENERAL•O• APPLICATIONS: Applications are valid fW 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.