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20-2007 Permit Application.nC. tSyv BUILDING PERMIT - • APPLICATION i'emnit#: D 1 nt S eve opine ervlces Building Division 121 5th 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 fries 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: S2-6 n��l Parcel:©I)q1 -% 2-oL ©0c) al n In Lot /Unit/Suite #: [ Subdivision: f �D PROPERTY OWNER: Name: s s U L� n jj Mailing Address: City/State/Zip: Phone #: U� •- 22^1 c S®d Email: E V () L`CS ( (2UJAA1 L_ • CGM OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes�No I 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: TFAWA 5 t ` d t Mailing Address: 'Po Zo �.2; City/State/Zip: p��L �VL,I & A �' Q C� Phone #: 10 p q b — V E-mail: ���� 1 T(W Z- `Y4NEKs GENERAL CONTRACTOR: (If different from applicant) General Contractor: Mailing Address: City/State/Zip: Q Z Z Phone4r. E-mail: i'YllM. STATE UBI lG o r4 (7U Sj CITY OF EDMONDS BUSINESS LICENSE #: 149 U Gb WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: �Q51 Q013� 06' �- r--Z0 (ProvideTYPE OF PERMIT Deialls on Page ❑ Accessory Structure/ ll Addition Detached Garage ❑ Demolition ❑ Mechanical ❑ New Single Family / Duplex ❑ Plumbing ❑ Remodel ❑ Fire Sprinkler ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑ Tank El Tenant Improvement ��77 n LI12, Othegef214 Remodel Permit fees are based on: The value of the work performed. Indicate the value (rounded to the nearest doilar) of al[ equipment, materials, labor, overhead, and the profit for the work indicated on this application. Valuation. PROPOSED NEW SQUAREar r• THIS APPLICATION Basement sq ft: k163\ Finisheci`yl Unfinished ❑ 1st Floor, sq ft: [ 2nd Floor, sq ft: 7 A Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: LEA PROJECTr ttZCVA(R _DA W A(4 1E� TO ._ �Ut.TINl 4 VELA `LCL-,; L VV\. ACT- 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 Ci�t of Edmonds. T� 12_' ._FZM V A D\AE I Print Name: S � L-�-V— signatur : Date- 2 g- GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped) BTUs Qty BTUS Qty Occupancy Group(s): Occupant Laad(s): jN' Type(s) of Construction: (v1 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 BTUs Gas / Flee / Other CRY 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: QtY Qty Clothes Washer �A_ Tub/ Showers Dishwasher Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve i Floor Drain/Sink Refrigerator Water Supply Hose Bibs Water Heater - Tankless? Y or N Hydronic Heat 1 1 � Water Service Line Sinks I I I Other: Toilets I � I Other: A/C Unit ���� Outdoor BBQ/ Fire pit (l% I Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace MEDICALGAS. Other: AIR VACUUM COUNTS Rel6cated. .. . ntv QtY I Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: ��