FIR2020-0068+City_Application+7.17.2020_11.49.38_AMBUILDING PERMIT
APPLICATION
Deer elope enll Services
Buil-ding Diwi5ian
1 :2 1 nth Ave K i Edmonds. WA 17S0:20
425.771-0220
far lhtrrhdoeN. ppbmMjMW rff*rrJFEMeotf po ta: W%ffi,ednWH&Wa.y$v-
To Opp e+f�,rprrrn tM srM1.-&k kj$prrtoMS� 6V c herk' 431903UCU6DD 511?1U6
go tp: wrww-TybLii it- r:om
101B SITE WFORhrIATI0N f 10CATIDN' (Where the wont is Eakin$ pla€ei
loID Site Address
Y C° &-- t -5hv e 4-
Parcel: 61) L;1'/ 2 0 I'W d 1 760
Lot {Urriq/ lte 4: /f / 5ub�dlwlsion_ _
BUSINESS OR PROPERTY OWNER:
Name; C I%a r-Rj `r'411 O eder
Mailing AddFess; + ' P
Cityrj5tat-@/ZIR' A 4 q(a Z.-V
Email: 44 0-— VL-A 4�- #.54, r7 el _
OWNER INSTALLAMN; 'If yej, read and sign'
wil I work he pefEi>fined by the propurtyr o'•': ner? LYe5 71N0
I own, r wide in, or wi4l resi-dr in the completed structur-e. This
Installation is lacing made on propeFly tho l 4 o" whkh is not
Intended for sale, leaser rent, or exchange according to RCW
Owner 5iEMJtufe:
APPLICANT { CONTACT INFORKAT1ON'
dame of Applicant: M 04n l
Mailing Address: f ya ddrh" O+ (f gt p_ Pr 4'4
City/-1-1 to p! (A e v--L-P$ t� Z
Phone a:-7
E-mad- 1-yra`L�iaA
4�ENERAI CONTRACTOR! [IF diffeFtnt Irom applklirrt}
General Contractor; ti(I O Li FAC
Mailing Ad&4r ss:
Clryistate{iip;
Phone P:
E-mall:
STATE U014:
CITY OF E pMIONEFS BU:9HESS LKENSE � ..
WA STATE CONTRACTOR L & I Jr: (CCB) AL EXPIRATION DATE=
Pe-M i
Accessory: StruCtu re{ Addition
o-eta(Jhed Garag-2 0
Demolition Mechanical
New 5ingje Family/Duplex Plu nrhi ng -
I ' ' ire Sprinkle* � Rmfldel
#Yew Comm-erCiRI jMbCed Use
5iigns
Ter`an1 I rnprar'emenl
Rernodel Farr l lees fire bused OI~;
Re•Raof
Ta nk
n Other
The wMe of irie-cork perfom3ed. IrKAcde rho +clue frouncled to
frre rw�-0116,51 drAy f or ciII equipmcni, rfinleriois} k3". o++erl-pcvd•
3qd rile proiln tof the wrxk irYMnied on this CM"l •
volvgtlon_
Pit0P,0Sf- b N EW SQUARE FOOTAGE FOR TFI 15 APPLICATION
■
GarapjCa rpOrt:, sq ft:
Deck�Coy ered PoccVPaM'
it gf NEW &drortrms! a Q+ NEW Bslf,roomv
;T05t,l l K 5err'aiL iff Ae'n
74}VFg4 X: etc.7<$
v
I r.aellfyr that the irAwmation r Fyne pf-DMrdegl nn this lorrnVapplrcatwn i5 7rue.
orreii and €wpvhr, prrd that I arm U* pmpertp owger -or duly Rvfhori-d
20" of the p+aperty dwrW 10 5dWit a pprmn applimtmn to the lily -at
Edmands.
-Print Name
signature! r- Bete -7- Z-ar.o
OCCUDaFICY -i r-0UpjS}: I ifircuparrf I wd(51:
Typed&l of Commuction! r r e Spfinkiers: Yes ZN1511
WA STATE ENERGY LADE: if your projecl affect& the building envelope,
mechanical yMitma, ;pWgr lighO ng, yrou muF# wrnplicte Chi:
a ppropriate WSEC forms.
DEFERRED SUBMITTALS: All tommefcial building permit& [hat will require
msixia#ed plumbinL merhaniLRl, fir-e5pnnider, RrKVur fire. alarm
perm rU are applied faf sepairaLelyr.
TI i,` CH AWSE OF USE j NE'A' lrrlWc�u- TRA; FIC IMPAC' worBheeS
COUNTS
STU& Ga& { C-ec 0' •,ar QtY
AfC Unit {Campressor
Air Handler IVAV
6gJ{Gr
Dryer curt
EKhuust Fans
Fireplate
Furnace
Hear Pump I.Mit
Hydromic Healling
Sucif Top Unit [Pmode Neua-
tiam 0 a [omrnerc6A Bldg}
; I
Culler_
Qt4 0AY
Clothes Washer -T Tuhf Shower&
Dishwasher 'Backflow DevffA 4RPBA, DC❑A, AVaI
Drinking Fountain
-Pre5sufe RedUtdani,` R"ufawf Valve
door Drairr}Slnk
Refrigerator Water Supply
Hfrse gibs
water Heater - l6inklm7 V akr N
Hydranir. H-at
Wotz7r ScrviM.. L ins
SiYrhs
other'
Other:
TolleU
CONNECTIONpiped)
? WS i](•r BT J5 (�W
Ar C Unit
Ourtdaor BRQ f fir- pit
Boifef
Stove/Aangp�Over.
Dryef
V:aTer'HVa4F
Flreplacei Irr&ert
{}then:
Furn Other:
MEDICAL GA5, AIR VACUUM COUNTS
CRY cn
CBrbon Dionidr.
14 rtrou5 Oxide
Helium
"Zen
Mladre,;iil Air
Other:
medical - SUNIcal uKuum Other!
7y" crf 5finr'ctLFre to be dear 10ed.
Square footaL-e & structure to be demoWhed:
AHFR,a $urwy done? W[ T C P5CAA Case rf:
Cr6tal Areas Determination:
5t,udV RE qu rred D candrtrar►al waiver ❑ wa-ver Q
Fill In Place ❑ Fill Material:
Rernaval ❑ Sir,- of Tank �62jlk)w)
CrMCal Areas Determination:
Study Rm j -fe 9 Oondlli mal Waivrr X FWgr
GIRADEJ
GraMrlg:Out cubic yards
FIII _ cubit yards
Urt a FIN In Cribcal Area- Ye& ❑ Nc, ❑
■
AIPPUCATIONS: AppikzHans arc valid fgr p rrypwmum cf 1 Year,
ESLRA Applicatipns, 2 y c4 rs.
LICENSiNi2p: All rrprttr 0r$ and 5Ubr,0r+traMr5 arc required to tue I-cenSed
wIM washingLcm State Deparmem of Labor & Iridu&[ties and have a
ouireLnL City M €dnxmds Business Lip-ns-.