FIR2020-0067+City_Application+7.17.2020_11.48.53_AMBUILDING PERMIT
APPLICATION
Dew elo p MOM S ervic es
Bu it ding Division
121 5th Awo K { Ed m on ds, WA 9.01020
425. 771. 02 20
For p4 [xa: www.edrthdsWO dk,
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JOB SITE INFORMATION1LOCATION: (Where t reworkK taklrig plane?
lob Site Address: Cf� 0 �.� 5 Acc j-
Pa roel= e)o q3'1 Zo.1 C Vii 7r 0
Lot �U nit�Suite 47 � 5utsdmsion:
BUSINESS OA PROPER Y OWNEW
Name; Ira rigs G/,r, veeje r*
Mailing Address: OHO ! ` Pkc1�
Xl-
CAyj5tatfjZip: f df & weS
Phone #: p 2 SL)
Email' C �%ej� 5 _ 1 (- r).- ( t
OWNER INSTALLATION: 'rf yei, read and sign'
Will work be perfotme�d by the property owner? F7Ye5 [allo
1 owr1, reside In, Dr will reside in the wi-noleled sttur-wre_ Thks
Installation is bei nq m;0de Ord prppertyr that I own which is riot
intencied For sa le. lease, roll, or exchange acwnding to IRE-W
13.27_090.
Own& Signal urP. _.
APPLICANT � CONTACr I4Y FORMATION:
Name of Appllr-ant: + '
Prone 3t: �. r
E-mad: 14rr jdl 4 -1.
is E NERAL CONTRACTOR! (If differerrt irum applkarirt f
General Contractor: 04rW-,.P r-r;C ' x iet it d -
Mailing Address:
CItyAtate f.ip:
Phone, IV-
E-mail:
STATE U01 #; UOq' '19 -71g
CITY OF EDMOND!5 ELU54MISS LOUSE it,
WA STATE GDNTRACTOR IL ik I *' (CCB) 1k EXPIRATION DATE;
A{oensflrf Structure{
p+e acMd 43arage j Ll
Oernali Iorn
New 5i rigle Famllhi/Duplex 1❑�I
1 r Remodel
New Commercial}NMix-ed U&t
516n
❑ Tenant Improvement
Add itiori
meeharlical
Plum ping
Re -Roof
❑ Tank
❑ Other
Remodel E*W1 f**s c1re bowd an'
xr3k.ke of tM work performed. IndicQlc ihv wt lue (rounded io
the nearesi dolor of 4A ggrprrcni, irr,3i&rkAi. I bbf, orefhead.
pnd FF� r�i::iil rof the work kxNcoied cn Mt9 oppli-_I,
Basement 4 tk' F
lit frlppr. 5q ft:
2nd Flp,pr, sq W.
GaraWel{arpvrt;, sq tk
Nc6{fcawered PDrch0-.7da-
Unfinished0
* of NEV: Redrii-Brnt- Of of NEW Sathroorns-
94fC,g1,00# ft'; -AOMC r
I certify that *i! informamn 11.4E a proyided on this krirVaaprkatim 15 qfw.
[orre:t andmm"e, and Lhat I afw1he pr¢pW4 0.rrpror dA aWhoriwd
qt!M bi Me prdper(y nwtl@e Co AbMft a perm* applk;iMrh io iha City of
Edmondrs. j
glint Nagle:+ Y w
Occupancy-Group[s]' occupar+t L-Dad(sf;
Type1,) pF Cpnstruttiori-
Fire Wirwder5; '+esE] NOD
Wilk STATE ENERGY Cl)UE: If your project avflects the building envelope,
ryimhariical 5y5wns, a nd�or I ISWFI& yqu Mull b7' plete the
approprwki� LVSEC corms.
IMPERRED SUBMITI-AS: All iiomme rclal bubliji g perrnrts that vyrid rirgyir*
associated RlurntsN, rnechanical, tine Sprinkler, andjor•fisre alarm
permits are spoiled for separately
TI ? CHANGE OF USE J NEW BuDa 'rp i, ve TRAFFIC IMPd7 wwk#tieet
EQUIPM ENT COd
117Us (ia5 I F K3c f clthar QtM
AC Uri t }Compressor
AIF Handler tWAV
Bailer
Dryer Duct
Exhauo Fau5
Fi-replace
FUrnaCf
HC.Rl Pump Llrril.
Horcmir Heating
Roll Top Unit (Provide ek-ra-
aiDft iI a CQftAr{Y IRI eift)
OthEF;
Clo#he-s wpshcs iutV Showers
Dishwasher
eackirlaw DeYIve JRPBA, IDCOA. AVIRI
Drlrikiilg Fountain
Pressure FWdu[tiomd Rr$ulatar Value
Floor D+ralnj5lnk
RQf-W2t0F Watar.5upp1M
Hoye Otbi
Wmi-pr Hrmirr - Tarikle530 Y or N
Hyrdramic Heat
WatfF Service Line
sinks
Other-
ToIIet5
1)thir r-
■
MIS BTUs Qtx
ABC Unit E)utdoor BBQ I Fire pit
BO&F
StDwe� a�6e� +en
pryer
wager Heater
flreplace� Insert
Other;
Furri$Ce Dther:
QEY+sky
Ca rtlon DiDx de Nitrous p),lde
Helium
ONYWri
Medil�all AiF
Other -
Medical - Surgxal VacUurn UkMer,
Type 0 itF+ Mira Yc� t-C drmalishrd:
Square ftpt;lp cyf struoure [a be der clWhed:
Al I ERA Survey done? Y❑ IN[] PSCAA Caie F;;
CrMLal Areas Determination: Stu* Alrquired ❑ Cotditional Via L] Walyer 0
rver
FIII in mate ❑ FIII material:
hM Dwal11 Size of Tank Ifiallorisp
Critical Areas Detetmiriadoir:
5tudy AfQUI►ed COndikiOnaJ waiver WpiY4F
ml
Gee": Cut cubit yards
FIII cubic yards
Cut I FBI In Critical Area: Yes 1:1 Mo❑
APPLICATICPNS: Applitati�xis a r-e slid for a in"imurn of 1 year.
FkHA Application. ? yeprs•
LICEMING- All Wtm;Qrilrai;sors are required w to licensed
Wrth Y m.1iinLrton Skate Departmerrt 4t Labo+r & ■rm*striet and have a
turreret City of Edriwflds Business License.