BLD2020-1044+City_Application+10.4.2020_7.06.31_PMBUILDING PERMIT
APPLICATION Pam-il rr:
Deve-lopmcni 5-errir-as
Boil-dirtg DrivisiGn
1 :2 1 SfFt Ave N 2 Edmonds, WA 98020
4:25.771-0220Aaeessn S>�vct�rre{
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TO dPJJ'J PWMFtF, xFwduk rrapaetivM-.'S, or OW* PPPffiPVkD Ftgnm
go 9w Nnanu�n�'�vifd!n4prfrrrr�tUTa
JOB SITE I N FORMATION/LOCA-nCM';Vlhara tha umFk Is ttaklrrg phca}
kL: Sits Ad -drew:
Parcel:
I.at;'LJnit;'Suite. 9= Subdirisian_
BLJSINE!35 OR PROPERTY C WNER;
G
Name:
Mailing Address: '
Cii�r{State�ia;
Phane #:
Email:
CONNER IINSTALLATION. 'If y d vnd ,;igni
will work be performed by the property owoer? ae5 El No
J ewrlr reside in, or will ride irk the tom pl-etedAgrucWre. This
insullatian is being made on proputy khat I awn which is nut
intended for SaLe, lease, Mats xC ar g to RCW
Qwner
A PUCANT f COWAGT IN FORNIAFI0 ,
Name of Applicant: ,
Mailing Address: Q622,92- A i 201.
City/statelzip: —
Phone #:
-GENELRAL 1CVNTRAU1)R-' [if different from applicant)
General Con:ractur;
Mailing ,address:
tom} j5h0bv{ 7iP:
Phone n:
E-mail:
$FATE LJBJ U:
aTV OF EDPAIDNDS R�iJSINESS LICER SE Rw
WA STATE WNTRACEOR L & r M EY PiFrAnON DATE
Ir
Mach ed Garage
❑emulidion
y❑ Nc'a' Sirq�le Family/Du plea
Fire Sprinkler
New Cadnrrer&*rvlixed Use
Signs _..
Tenant I m proycme:L
LJ Addition
Media nieal
El PlumNng
Elf�eet5od�l
R�Rt+o�
❑ Tafik
❑ Other
R*matW Pmmit fps oar based an=
the rra?-me cf We work pcfcrmcd, YeAL* ffour,ded 10
.FC n�7H�4f ddW� Of �I rr_LaF,�rrd, rricleribLS�;abor, O G'r6bd.
and the wca br the work -nccc t~c vn Wds: umi�r3hon.
Rasemerrt ,q ft. Finished
]st Floor, sq t`
znd Floor, sq ft
Garage?Gam" -t, sq f-
Dee4Ceti-cred Pordif Patio:
ar of NE-0 Ne.- rooms
L0p-•5-ied❑
U or NEV: Eattvmm5:
cartifythat tm In farmaton I have p;ayMtJ un tIIix r-orr4;irvbcat-n tst-P.
eatrcLrt amd immplatrr, and tit F am the property ~,K or duk—hort?ad
a@.crrt of'he property owner W mbink a IwwnIt appiIcat on to the Cit1r of
Ednwmft
Print Name;
iSigna#u _k Date
�jpanc;y GroupIs): ' (2—pwl# load[sj_
Tkpe(31 QIF CCMSUCWmc
Firm Sprinklem Ywo MOD
WA STATE ENIRGY i -DDE- If V Qw Mjett of ec the bulldYlg emrelap%
mech2rniwrgritems, and/oe Iig"M yrou rrnust. prnprete Lhe
amiP+lakL WSEC farms.
DEFERRED SUBMITI-A PJI -D=lnerdml building p&tnilh that wNI require
assadaLed plumbinL nle fi&"calr fire w=lnklei, arid/or fire alarm
perrnitT; ane applk<fW sepam glyr_
Tlj CHANGE OFUSt) NEVY BLDG:IrAode TRAffiC I MPACTY5&Sshek
F
37Us 3as J Elec f 0,her QEy
I
Ay�C UniC jCOYrrrrvpr
frlr 4awile: /VAV
SOLK
Dryrcr 0u t
Exhaust Fans
n replace
Furnmog
Heat Pump Unit
Aydrsoic J-ieAng
Ro�i(Tcp Lfnit iPrg4ide. elrya-
Mns f a CwftffwrniaF uklpel
i 1FFar J
�
i
-.�% L lr7-�- I f A I,, L-L.3
5
Out Fws Waller Tubs Shower;
Dishw;ks ler
Badz%w DeYlDe �FWBA, DCCA, A4S)
Drinking Fountain
Prcswre Reduedon} Lvr VaFfwe
Floor Drain{SirSk
Refrigerator 'Nato 7upply
I
Hose EL:bs
V1;;tar Aeat-er - TankIeta r Y cr N
Hvdrooic Hmat
Wa"r SerSrioe Line
Sinks
Other
7'oilet5
OkFrer
STUS Qty F+! 4'S Cty
JVC Unit.
OuLdwr BDO f Fire plL
Boilr. r
5tD4e{R$h�rr`{}r��
Dryer
1h'aef Heat&
Other_
Flrepl&mf Ingert
Funacp Offer'
(New, Relorated or re pfped)
' S`} L+tl
Carbon• D; i.-r
XftmuS43xfda
H 4w.,n
Modic;'.Ar•
DLher.
PA&Ci2hl-5urenl Vacuum
Other.
Type-f :51rvciture t be demaIishcd:
&IL2 re (oobeg 40f stRX-tUre to be demo?i Lied:
AHERA Surreyrdaae7 Y[JJ N[j KCAA Case W-
—
' Cal Areas Deberm I n aft flc
S✓6udv Required cJ Conc itianzd Wlfaiver ❑ WaiverEl
Fill In Place 13 Fill M:bccig
Removal 0 I Size ofTank{GAIlarls?
CItHC 31 Area DatermFri atlan:
SWdY Rtquired Condfonal Waiver Wa;?Ver
Gmding;Qt nib icy-.pn;K
CL16k -ywds
Cut { Fill in Ctitiral Area: ns ❑ No ❑
APPLICATFON5: ApplicaMns ate valid for a maiinyurn pf I year_
MHA Appllcailon%. 2 vMrs.
1. EMING! All con radars wod sabcontra-^tors aye required La he Iicansad
-ith washlnfton State Demrtr1 -it Df Labor & Indµs',-ie-, and have a
curF*nt Cfty of Comor•6s laI,sinem Llcens,...