FIR2020-0069+City_Application+7.17.2020_11.48.14_AM'no 1 �9-
BUILDING PERMIT
APPLICATION I F•eirri' -
pW-W Ljtj—.v 5er,rices
Boil -ling Diviy ion
'121 5th Ave N J �d minds, WA 45020
42 5.771.0220
FQF hOrtGfOL.1M g&tV: F4•N•N' L�%". _
Tp ppp'}' fpF prrmfts, schMiek- irupertians;, w check appficr?6an stoles
go to: www_rrrybuiin�lrrtiii. COrri
JOB SITE JNF0RMAFT10H/I :FCAMN' (WU here the work is taking place}
Job Sete Addres ; n '�e vi.
Parce!_ G Q q3 � 0 9 4 0) 700
LotYUnitjSuite #: 301 5ubdivi5ion-
BUSINESS OR PROPERTY C't NER:
Name: ( �a f 1e 3 U ,
Maili" Ad(lreSS: -/.,/o /; ii,� e
CIW/State/1P_. L� mod JS , �_j If V'-0
Phone #; wr - -.� 9-0 - z �-
OWNER INSTALLAMN: *If tins, read and sign'
WilI work be pesformi�d by the property ownef?�YesENO
I own, reside in, Of wil I reside in the oampleled StruCturt,. Th iS
in5t211000 is bung made on property that 1 own which is nut
Intended for sale, [ease, rent, OF exchange acwrdinu� to ACW
1027090.
Omer Signature-
APPLKATYT7 CONTACT INFORMATION-,
Name pf Appl iG.pn#' . J + DdbL,
Mailing Address: NO 1 j 1:g n 117)- CJ i
Phone p: LIZ5-
E-mail: k jr7 J crC �J I' CA ri.r•..
[GENERAL Co NTRACTCI R_- [If different frarn applleant)
13emraIContractor: frra'^a rAp— ro + t b.�
M2ilinS
+{Staw2ip:
Phone p'
E-mai I:
STATE U$1 #; �rr' gV'V e Vr,' q
CITY OF EDNMONDS 9 USINE55 LICENSE
WA STATE CDNTRAcm R L & 1 It: f CCBM & EXPIRATION DATE:
14( r �-.) P. P9L/ / Pk / � _�p - r
AC"-SWry$trUCtUFej
Additl
De.Whed GardRe
on
Demo1[tion
M4-cha nlcal
+New Singe Fami IV/Du plex
Plu mk)rng
, Fire 5ptrnkler
Remodel
Re -Roof
New Carnmerciall Mix-ed Use
n
L❑�I
Signs
n
1�❑I
Tank
Ten;)nt IrS� 01'grl7 rt1
Other
Iternodel Pe-rmh lees -are based orr
1 he value of the work performed. hdicale
the value Iroundod ho
the rKxxnr cRAbrl 0 oil cquipmi!�nF, moo rills, R:3i.xy. ow$F ,
and the MrH for the •,raM indicated on this applcaikxl_
�O1Ufll14Tt:
@asernenk sq ft -- Finished ❑ U nf, r . I
iu Floor, sq ft_
� nd Flppr, $q ft:
Gara®eioarpart;, Sq ft-
DeckfCovered Pore"Min-
A! pF NFv: Bedrwms:
a 47F NEW Owthrporn*-
t Sir+ LJ er VS+ +,
I rcmFw that the Information I hxh%. pmMrdpd on this Inrmfapplk;irlpn is vim.
rorrcci and cornplogq and that I am ihpp pmppnp owe*r or dy,tr aisihWi3ecl
agen7 Di Me property awner to sAubrnrt a permit applreatwry Ro 1hPP CJtS of
EdrYibndt.
Print Name- 74,$OA, k Y
54nature; Dade
L. .
-occupancy+G■ou05}' 1 Occupant Lad[ ]=
TVp4 s f pF CA) n;try V pre: Fime Sprinklers: Ydqs 1z Nq ❑
WA STATE ENERGY CODE' If -your project affects the building envelope,
rnr.chanical sYitLLMI, 2indlor li$hd-ng, " mu i eomlalett the
appralpriat,e W'5EC forms,
DEFERRED SUBFAIT I-ALS: All iomme r{lat bubldlra perrnrts that w lW requalre
as%-xia7.�d piurnbirlg, mechanical, $re sprinkler, a nd jor fere alarm
perms" are a ppkd for separatelY-
I I I CHANGE OF USE j NF W OLCIG: ■Klp¢q TRAFFI{ IMP:.(i wprk*he*t
■
i I lJt {sat ; h me r { J, nctr lit,
A.fC unn jCarnpreuor
Air HandlierNAV
dOiler
Dryer Duct
!ExhauA Fans
Fireplace
Fu rnace
F1qu1 pump Unit
lHydkpurc Heating
Roof Top Unl[ �Frtmft ert.;k,-
rims rf a Cornmrrclal Bldg]
Other:
EJP40 FIXTURE
Wy
Ck:-thPes Washer
COUNTSPLUM or re pl;ped'i
T-uW Shower%
Dishwasher
Hackfk�* Device (RPBA, XDA, AVS)
DrIrrkIrig F+DLi Malin
Pressure RedivcHonf Regulalar Ya#r<e
F Dr aralrV5lnk
RefgerptDr Water 5UppWy
-lose Bibs
W; ter Heater - Tankless? Y or IN
Hyrd rorrlc Heat
Water 5eryKe Urge
Sinks
Uther:
Todlets
Other:
.;-kj% Cay BTUs MY
Aft Unit
Outdoor GfiQ{ Fire pit
E Dller
Sto%*JAange/(Nen
Urger
WaiDer Heater
FirepliCej Ifteit
Orher:
Fumaae Other:
MEDICAL GAS, AIR VACUUM COU NT5
L1;Y cnv
Carbon D We
N rtrou5 Oxide
HHIUm
Oxygen
Madr-BI Air
Other:
I - Su4wl Vpcupm Other:
■
i
Tqc 4F struiurit to bC dcn-pplished"
Soare Footage bF Stj'uC#uet %* b* ¢grrpiiFh d=
AHERA Survey &n0 YC] 1 C PS€A.A C&s,e *:
Ofirleal Areas Deteimratiun:
Study Required [7) Corgirtionat w arver ❑ Waiwer o
Fill HI Place D FIII material:
N)emWa1 7-1
$im 4l Tink lGallonsi
Critical Aueas Ortrrrnan;ippn_
Study Required Cof%d Rional Wd ivei Waiver
M
Gfading: Cut fiuble yards
fill cubic yrprd5
Out f FIII +D Critical +sea' Yes 0 No E
APPLICATI-ONS: Application* pre vplid For a mamirnUm of 1 year,
ESLHA dlrpiirp ions, 2 Yea►i.
LICENSING. All oofnfamfo anti iubconUBctoa are requ ired to he IicerYsed
with Washington Skate Depa rtrnent Gf Labor & IndmVies and have a
currcnt City of Edmonds 6usinem License.