FIR2020-0066+City_Application+7.17.2020_11.47.23_AMrr�' 14')V
BUILDING PERMIT
APPLICATION
Dovelopm ent -Sery is 15 s
Building Div lslon
121 Sth Ave M ? Eden on ds, WA ?0(120
424,771.0220
F,pr 03pnL10LJ , 54.161'Flortaf reQ0&Vf 'At5 go Zo: --6V edrtl[)(1oi" Wo%,_
ro oppOy for peffmf f, 5rhL-, 4rJe irm p ft tic Flt} df check apaLcntrarr :tarns
go to: www_myhui8dony"fm,t [prti
JOB SFE INFORdAATIONJIMATION; [Where the wcwk is taking place]
Jab Site Addre!i6: p 11 .5 Y-17L
Parcel: 00 Y-?q 2 Vq? 017
LOt /UnitfSuibe 14: k&1 Subdivision:
RUSINESS OR PROPEWry OWNER;
Mai ling AOdre55- _ _ AAer i,,
City/Sbatefbp=—
Phone:
OWNER INSTALLATION: 'Ff yfs, reed arrd sign`
Will work be performed by the pfoperly owner? F1Yes 9NO
1 Own, reside in, or will reside in the completed struCture. This
I-tstallatiart is t-ing maMd On property that I yawn which is not
Intend TOr $dle, IpagQ', rent, ur -exchange arcordjng to H(;W
18.2 7.0W.
Owner 5ignatuie:
APPLH�A NT ) irONTAi`T IN FORMATIOW
Name of Appl Kant; _ rix 4,4 `{
mailingAddress: IYD 14�ZVtla-FA i �+•
Cityf5tate{2ip: C.k 2 fin^
Phont N. - 3v1- �r 70•1
143ENERAL CONTRACTOR: �If diHeem from ;appikiintj
General 1�ofltractor; Ii: a rra.j
mallang Address:
Citv�stat-ejzip:
Phone Ot:
E-mail:
STATE UEl #: L'b y cy ir V 9V
CITY OF EDMON o5 a USIPIESS LICENSE *-
WA STATE i<ONTFRAETOR L a I N_ I ICBF & EXPIRATION DATE:
❑ArLeSWrY Struetueel ❑ Addition
Detmhed Garage
Demolition Mechanira I
Ne r Sin& Famifyff Duiplex
Fire Sprinkler
71 New CQrr merCial f Nliwd Use
Signs
Tenant Imipray*ment
Remodul PermH fees ore Iaased on
❑ Plu mbi ng
Remodel
IJ Re -Roof
❑ Ta nk
Clthee
The YIAJ& «I ih� work pc6D rn6d. Ii-91coie the ,slue frounckRO 10
H"e nexest dol10rl i>r<3II cquip-cnt, mfltefbl5, bbaf. overtheoa
OW i" piraf iar 11-16 wD* OIdlcated oil lhis opplWii>n,
Valuartlow.
Baserner t sq ft.
1st Fes, sn ft!
2nd FIaar, sgft:
' Ga rage�Carport:, sq it:
fr�d RorchPatlo
Unfinishcd11
iiii of NEW 9elfoorn$: R Df NEW eathfpprns:
I tnrldfy WiC the WdvrriAti0n t have praMrded on this i} true•
rorrcct and compkgiq. J6.0 thal I arr+the properly nv ner or duly amNfHelQ
POEM 01 tAe Of0perry dwner to submit j, permq applKaNf)101Ihe City ar
Edmonds.
Prf nb Name, J )j Dq4 if
Signal-ure- Y .' Date -7-le ' 2-92o
GENERAL COMM E RCIAL DATA
Occupancy Groupit): Occupa at Loadtsl.
rYP-E�5} Df Con5truCtlon; Fire 5pr■nklus: Yes FrFfoa
WA STATE ENERGY -1-DDE- If your project aff-ects the building eAwlope,
nxclrar;ical systems, AncV.5r lighting, yf3u mutt tor'nplete the
approprlateWSEC farms
DEFER RED 5UBMFTTAILS: All commercial building permits that will require
3ssotiatM plurnbin& meth"icblr Mee sprinkler, and/or Ire alarm~
permtts are applied for separately.
TI j CHANGE OF USE {NEW 16LDG' Incltide TRAFFIC IrAPACT WorN5hE4-
■
51 JS Cat Elec I Othef nV
A/-[ LI a a /Compressor
Air #larAler /VAV
�pil�r
Dryref Dact
£xh*ust Fans
Fireplarx
Fu mace
Heat pump Unit
Hydror► c Heating
Rc f Top Unit {I cmde eltejr
dons rf a Cammffrcial Bldg)
-
other:
PLUMOING FIXTURE • Relocated or
Qty Qtr
Clothes Washer
T%jIV Showers
Dlshwasher
Bac4ibw Oe,rlce (RPBk DCDA, AVI3)
;DriirAin Fou rrtaIri
Premure Redw:t on/ Regulator Vsfi*
FkkDr Drairr{5+rrk
Rw4eratvr Water Supply
Hose Bibs
water Heater - ■ a+Ikre55? Tor N
Hyrd<ow Heat
Water 5ervcce Line
Sipks
Other:
Tollet5
OHrer-
Relocated .
a I JS U(p STLK Urr
+JC Unit
1)utdoor OW j Fire pit
Boller
Staye/Rangeloven
Dryer
Watt■ Heater
FineplKej Insert Cither:
Furna[-E Other:
COUNTSMEDICAL GAS. AIR VACUUM
Q O LY
Carbon aibuide
Nitrous Oxide
Helium
Oxygen
Mtdir,sl Air
Other:
M" ical • Su rEical Vacuum {ether:
I of structure to be WmDllshred:
Square footMEr of structurg to be dgrrrpliFhPed-
AHEAA Survey dDr-e? V ❑ 1 r,� RSCAA Case 0:
Critical mat; Detrrm,rrapan-
5tudy Acquired ❑ Cvnditicinu: Waiver El Yu iivcr ❑
FIII KI Place ❑ rill Material:
RembveI 0
Size of Tank lGallnnif
Critical Am.;K lEirtPrmirypon-
Stu#y Required CorrditiDnal Waiver Waiver
Grading_ Cut :..I) :
Fill cubic Yards
Cut / FIII W Ckitieal Area: Ve& 0 No
PROVISIONS
APPLICATIONS: Applications pre valid for a maKlraurn of 1,9ear,
ESL HA Arplirpki4ns, 2 years.
UIENSING: All conlractnm ; � s brcintrartur5 a;e requited to be II[eri5eo
wrth Washington State Department of Ls hqr & I rW%jStricS and hwe a
4;urreM City of tdrr'*rd5 Bu5irFe55 Llcerrse.