Julie Cobb-Cooper permit Application'nc. 18`)Q
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 appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: (U c-i T V--`YYn �'\& C .—
Parcel: Q01'5(91i 0DW'LflC)O
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Jv 1%e� LD1 U - l G<>Oed
Mailing Address: (Q'�)T ewy-\ 1�1l0`ce
City/state/zip: SAYY1JY\AS , \X A Qbo20
Phone #: Lisco LA I y-') o50
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes V 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: CM N\ecx-ly%dYi1\
Mailing Address:
City/State/Zip: p1e �-y klift Clbj0k
Phone #:
E-mail: ((40./1 er_ (m �iP_A-f 11Gr . CCZr, ,
GENERAL CONTRACTOR: (If diffgrent from applicant)
General Contractor:
Mailing Address:_
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE 62195\V
WA STATE CONTRACTOR L & I M (CCB) & EXPIRATION DATE:
kc7 —'2j\ '"2,020
Office Use Only
TYPE OF
❑ Accessory Structure/
Detached Garage
..
❑ 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:
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT•
Qeomg O"kf Y\a�\C1\e �
Wak
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: e l' C : L)vl�
Signatur to y o
GENERAL DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Cons ction: Fire Sprinkl . es ❑ No ❑
WA STATE ENERGY CO . f your proje ects the building envelope,
mechanical systems, and i ng, you must complete the
appropriate WSEC form
DEFERRED SUBMITT All commercia ilding permits that will require
associated tubing, mechanical, fire sp kler, and/or fire alarm
permi re applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL COUNTS and Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
i/
v! 1
+
l
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
COUNTSPLUMBING FIXTURE
Qty QtY
Clothes Washer
Tub/ Showers
Dishwasher
Backflow Device PBA, DCDA, AVB)
Drinking Fountai
Pressure Re ction/ Regulator Valve
Floor Drain/Sink
Refri ator Water Supply
Hose Bibs
ate eater - Tankless? Y or N
Hydronic Heat
Water Servi Line
Sinks
Other:
Toilets
Other:
GAS/FUEL• • • .•d
BTUs Qty ",13?Us Qty
C Unit
Outdoor BBQ/ Fire '
Boiler
Stove/RaZgven
Dryer
Wa ter
Fireplace/ Insert
Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
(New, Relocated or re -piped)
Qty
Qty
Carbon Dioxide
Nitrous Oxide
Helium
Ox
Medical Air
er:
Medical - Surgical cuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage o s re to be demolished:
AHERA Survey done? Y / N
PSC
Critical Areas Deter ation:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place ❑ Fill Material:
Removal ❑
�Slzank (Gallons)
Critical Areas Determina '
,Study fired ❑ Conditional, Waiver ❑ Waiver ❑
GRAD
jading: Cut cubic yards
Fill cubic
Cut / Fill in Critical Area: Yes ❑ No ❑
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.
Out door unit is smaller than 36" in height. Details below :
Model: SUZKA36NA2
Airflow Rate 12020 / 1930 CFM
I
Compressor Locked Rotor ! 16.OA
Amps
Compressor Oil Type/Charge I FV50S // 15.6 oz.
Compressor Rated Load Amps 13.OA
Compressor Type DC INVERTER -Driven Twin Rotary
Cooling Capacity 33000 Btu/h
Cooling Temperature 1115 / 14 OF
I
Defrost Method I Reverse Cycle
Electrical Rating ' 208/23OV, 1 phase, 60Hz
External Finish Color Ivory Munsell 3Y 7.8/1.1
Fan Motor Full Load Amperage 1A
Fan Motor Output 60W
Gas Pipe Size 5/8" O.D. (Flared)
I
Heating Capacity 35800 Btu/h
Heating Temperature 75 / 14 OF
HSPF 11.7
Liquid Pipe Size � 3/8" O.D. (Flared)
Maximum Height Difference 100 Ft.
Maximum Number of Bends 10
Maximum Piping Length
MCA
MOCP
100 Ft.
17A
31A
Package Dimensions 38-9/16" W x 16-9/16" D x 41" H
Package Weight 148 Ibs
Refrigerant R410A
Refrigerant Charge 4 Ibs, 14 oz.
Refrigerant Control
Seer
LEV
16.0
Sound Rating (Cooling) 55 dB(A)
_ I
Sound Rating (Heat) 55 dB(A)
Type of Heat Exchanger
Unit Dimensions
Un.it Weight
Voltage, Range
i Plate Fin Coil
33-1 /16" W x 13" D x 34-5/8" H
129 Ibs
187-253 VAC