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1141 VIEWLAND bldg permit ap°c. 189%J BUILDING PERMIT APPLICATION Development Services Building Division 121 5fh 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 call 425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: �7/ (// �Z-'� �( A Parcel: 0661566 O d(20/f o D Lot /Unit/Suite #: / L/ Subdivision: )�1��✓G/�^�DS PROPERTY OWNER: Name: ,✓ ��juc� Mailing Address: 6 /�✓uN ���02 �y City/State/Zip: 6k,�'f"2G' Phone #: Email: OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes 2-9-0 1 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: a:/d t__ 14i '_ Mailing Address: �� U�� ,ZrJ/ City/State/Zip: Phone #: 4?0 3 - IZZ E-mail: G Liles GENERAL CONTRACTOR: (If different from applicant) General Contractor:f��. Mailing Address: City/State/Zip: Phone #: E-mail: STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: Office Use On;,,, TYPE OF (Provide Details ssory Structure/ ❑ Addition tached Garage 7�emolition ❑ 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: PROPOSEDNEWSQUARE FOOTAGE FOR THIS APPLICATION Basement sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: DG 2nd Floor, sqft: G l3 Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT• 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. //JJ Print Name: Signature: Date 3 y 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• •(New and Relocated) 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: PLUMBING FIXTURE COUNTS. .. 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 7 Water Heater - Tankless? Y or N / Hydronic Heat Water Service Line / Sinks s' 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 Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: DEMOLITION Type of structure to be demolished: 25115- Square footage of structure to be demolished: AHERA Survey done? Y / N PSCAA Case #: Critical Areas Determination: Study Required L`d' Conditional Waiver ❑ Waiver ❑ NEENNEEMENNINEW 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 ❑ GENERALPROVISIONS 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.