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111 Sunset water line permit appIoC. I RWj BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements go to: www.edmondswo.gov. To ap+ for permits, schedule inspections, or check application status go to: www.mybuildirlapermit.com JOB SIT INFORMATION/LOCATION: (Where the work is taking place) Job Si a Address: 1 h 1 Sunset Ave Parce : 00434401300200 Lot /L nit/Suite #: Subdivision: BUSINE S OR PROPERTY OWNER: Name: Pacific Fast Mail LLC Mailir g Address: PO BOX 57 city/skate/zip: Edmonds, WA 98020 PhonA #: 206-295-0413 Email: sdrew@rmsn.com 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 install lion is being (Wade 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:1 Mlke's Plumbing & Drain Cleaninc Mailing Address: PO BOX 1535 City/ate/Zip: EdMonds Phone #: 425-776-0201 E-mail: office@mikesplumbinganddrain.com WA 98020 GENERAL CONTRACTOR: (If different from applicant) Genel[al Contractor: Maili g Address: City/ tate/Zip: Phone #: E-ma I: STAT UBI #: 602-114-308 CITY F EDMONDS BUSINESS LICENSE #: NR-026300 WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: M I KESPC99OKM exp 05/21 /2021 Office Use Only ❑Accessory Structure/ ❑Addition Detached Garage Demolition New Single Family/Duplex Fire Sprinkler New Commercial/Mixed Use Signs ❑ Tenant Improvement Mechanical Plumbing ❑ Remodel ❑ Re -Roof ❑ Tank ❑ 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 scl ft: Finished Unfinished 1st Floor, scl ft: - - 2nd Floor, scl ft: Garage/Carport:, scl ft: Deck/Covered Porch/Patio: # of NEW Bedrooms: # of NEW Bathrooms: 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: Sa d Ok S Signature: ���a e .31.2020 GENERAL• DATA Occupa cy Group(s): Occupant Load(s): Type(s)Iof Construction: Fire Sprinklers: Yes❑ No0 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 / CH NGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet COUNTSMECHANICAL EQUIPMENT . • BTUs Gas / Elec / Other Qty A/C Un t /Compressor Air Ha I ler /VAV Boiler Dryer C uct ExhaustFans Firepla�e i Furnac� Heat P mp Unit Hydronic Heating Roof Tc tions if z p Unit (Provide eleva- Commercial Bldg) Other: COUNTSPLUMBING FIXTURE • . or piped) Qty Qty Clothe Washer Tub/ Showers I Dishwa her Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink Refrigerator Water Supply Hose Bibs lic Water Heater - Tankless? Y or N Hydro Heat Water Service Line 1 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/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: COUNTSMEDICAL GAS, AIR VACUUM Relocated or Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: 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❑ 10 Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required Conditional Waiver Waiver •.. Grading: Cut cubic yards Fill cubic yards 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.