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Building Permit Applications'ne. I S4 , BUILDING PERMIT APPLICATION Development Services 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.eov. 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 files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please call 425-771-0210 to schedule on intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 3 Q 0 b , ,v E S Parcel: 00.1 -';�) !'ZI ZZC) 19 0D Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: C_K 9—k s P l C.�F�1 NCB Mailing Address: 7 04 MAP L15 ST City/State/Zip: F,ID M Otjy& WA '��?DZo Phone #: Z-C)(i — -A - 1 2J_51- Email: r_V1�%2Q � Op GDW'CCL�' h.ek OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes�o 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: G g iv�`� Name of Applicant: GA161 MAVU,5?-/ �� IT .T Mailing Address: 7 ZO!� 6P_F,1W V40 `D AVE N City/state/zips: SFhirt-L� W}'c g8I�3 Phone #: L0 b ?A 2— E-mail: bc. t� �ba"-�-�-ln• �oy�n GENERAL CONTRACTOR: (If different from applicant) General Contractor: LltP c O N sw)CT-1 ON Mailing Address: 704 MAPLE ST City/State/Zip::.DKQNDS WIAc M02-0 Phone #: ZO ro - Z ,7 E-mail: Qomc STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: C.0 LyT c o 0,95 Mc, OVZI/?- Office U`- TYPE OF PERMIT (Provide Details on Page 2) ❑ Accessory Structure/ Detached Garage ❑ Addition ❑ Demolition ❑ Mechanical >(New Single Family Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑ Tank ❑ Tenant Improvement ❑ Other Remodel Permit fees are based on: The value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. Valuation: Basement sq ft: NIN, 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: 3 "t-d FL?, t 1 Off' `, Finished ❑ Unfinished ❑ 2.10 (4)1Z 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 City of Edmonds. Print Name: �-��2 Data Signature: �; GENERAL COMMERCIAL DATA Occupancy Group(s): 3/ Occupant Load(s): Type(s) of Construction: V — N 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 MECHANICAL EQUIPMENT COUNTS BTUs Gas / Elec / Other Qty A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct Exhaust Fansi Fireplace Furnace Heat Pump Unit t/W�� Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE Qty Qty Clothes Washer ( Tub/ Showers 2- Dishwasher ( Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve I Floor Drain/Sink Refrigerator Water Supply I Hose Bibs Z Water Heater - Tankless -or N I Hydronic Heat Water Service Line I Sinks + Other: Toilets 3 Other: GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped) BTUs Qtv BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven (80� Dryer Water Heater ) Fireplace/ Insert Other: Furnace Other: COUNTSMEDICAL GAS, AIR VACUUM Relocated or Qty I Carbon Dioxide I I Nitrous Oxide Helium I I Oxygen Medical Air I I Other: Medical - Surgical Vacuum I I Other: Type of structure to be demolished: W Square footage of structure to be demolished: AHERA Survey done? Y / N PSCAA Case #: Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Grading: Cut 100 cubic yards Fill ZR _ cubic yards Cut / Fill in Critical Area: Yes ❑ Nq�_< APPLICATIONS: Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. LICENSING: All contractors and subcontractors are required to be licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License. 'ne. 1 K4- 11 Ilk BUILDING PERMIT APPLICATION Development Services 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 files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please call 425-771-0120 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 3 0 2- 60 A'-U '�'7 S' Parcel: �� !'Z` 1 Z2o ` Q DID Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: CA9-kS ? kcl F,E l Na Mailing Address: � 04 HA r L5 S� City/State/Zip: rp M ONiDS wA 0y Q DZO Phone #: LOCU -- dc ` 1 u=?- Email: rxl210i-22V� cowu - ' VuLt 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: �, G g pA NMP_1 Name of Applicant: �pAIM MUUX?_// Mailing Address: 7_ZO�N AQ5 N City/State/Zip: E,,h'M Phone #: ZffO V ? Op Z E-mail: ' b� cb - ax �► 1` - GENERAL CONTRACTOR: (If different from applicant) General Contractor: cl* C O W STP_V Gi 10 N Mailing Address: 704 MAPLE ST City/State/Zip: :6bK 0 ND 5 W 1� )20 Phone #: Z06 - �� 1 — 12_2_-_f E-mail: CA O W CA STATE UBI #: O CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: GL LtiPCQ 055MC_/ZI�L1 Office Use Only TYPE OF PERMIT (Provide Details on Page 2) ❑ Accessory Structure/ Detached Garage ❑ Addition ❑ Demolition ❑ Mechanical ------------- Vew Single Family uplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑ Tank ❑ Tenant Improvement ❑ Other Remodel Permit fees are based on: The value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. Valuation: PROPOSED NEW SQUARE Basement sq ft: > FOOTAGE FOR THIS APPLICATION Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2+� 2nd Floor, sq ft: 8�Z sq ft: V QO / FGarage/Carport:, Covered Porch/Patio: sq ft: 3Irck p PROJECTDESCRIPTION g 6 5 0 k) � 2:et �T uN� #- 2 C)F,2 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 City of Edmonds. Print Name: C� R_1S 1 C-�� �- (N•� Signature: Date�� GENERAL COMMERCIAL DATA Occupancy Group(s): S—Z Occupant Load(s): Type(s) of Construction: V—N Fire Sprinklers: Yes ❑ Nolk 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 EQUIPMENTMECHANICAL • BTUs Gas / Elec / Other Qty A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct Exhaust Fans Fireplace Furnace Heat Pump Unit Hydronic Heating I Top Unit (Provide eleva- if a Commercial Bldg) r: COUNTSPLUMBING FIXTURE Qty Qty Clothes Washer Tub/ Showers 12- Dishwasher ( Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink Refrigerator Water Supply I Hose Bibs ' Water Heater - Tankless? Y or N Hydronic Heat Water Service Line I Sinks 4- Other: Toilets 5 Other: BTUs Qty A/C Unit Boiler Dryer Fireplace/ Insert Furnace Outdoor BBQ/ Fire pit Stove/Range/Oven Water Heater %( Other Other: Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: BTUs Qty ME ON Type of structure to be demolished: 1 MAJ�Ae Qty Square footage of structure to be demolished: $Fj� AHERA Survey done?®N PSCAA Case #: LO) ��35 Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Grading: Cut Z-00 cubic yards Fill L_) cubic yards Cut / Fill in Critical Area: Yes ❑ No"K APPLICATIONS: Applications are valid for a maximum of 1 year ESLHA Applications, 2 years. LICENSING: All contractors and subcontractors are required to be licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License. (ICBUILDING PERMIT APPLICATION Development Services 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.aov. 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 files 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: 3 ��— 6 A'-U E s Parcel: _Q�4?72_oZt ZZO 1 Gt 1D Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: C_K9-kS IP lU.6p-1 we> Mailing Address: 704 MAP U5 &T City/State/Zip: r ID M O 1j'DS . W A 1t DZO Phone #: 2-0b ` c5c"i ` 1 u.91` Email: Gh� rM_ Q1VeQ-�NVtZk OWNER INSTALLATION: *If yes, read and sign* / Will work be performed by the property owner? El Yes >9 ( 1 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: ,, G 6 oA N ` Name of Applicant: GA161 MU e?-// Mailing Address: 7 Zoc exfm ,% do c) N City/State/Zip: ZOTppZ qq 18 Q26 Phone #: V `O—�1� E-mail: �o�bc�I@ cba - ax fin, C.OIM GENERAL CONTRACTOR: (If different from applicant) General Contractor: cltP C O N S-vp-\) I OK) Mailing Address: 704 MAPLE ST City/State/Zip: �JK NQ�S A Phone #: ?-Oro -- E-mail: STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: GC Lt1P r o D 55 Mc I/2-I Permit #. TYPE OF .. ❑ Accessory Structure/ ❑ Addition Detached Garage ❑ Demolition ❑ Mechanical AINew Single Family / Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑ Tenant Improvement ❑ Tank ❑ Other Remodel Permit fees are based on: The value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. Valuation: PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION Basement sq Tt: ruiwi au .,,,,•„�•• 1st Floor, sq ft: 8 I l 2nd Floor, sq ft: '4 5 0 Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT DESCRIPTION ?44- �JOhl coNSTP.UC_T ION 0IF: S�►� w���o for �i ty � 23 or 3 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 City of Edmonds. Print Name: C- C F- N Date Signature: ��� Occupancy Group(s): K- —�) Occupant Load(s): Types) of Construction: V N 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 / Elec / Other Qty A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct FL Exhaust Fans /l Fireplace Furnace Heat Pump Unit ��f ff &LE; Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: FIXTURE Qty COUNTSPLUMBING . • . re —piped) Qty Clothes Washer I Tub/ Showers Dishwasher I Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve 1 Floor Drain/Sink Refrigerator Water Supply I Hose Bibs Z Water Heater - Tankless? Y or N Hydronic Heat Water Service Line Sinks Other: Toilets 3 Other: CONNECTION COUNTS• • or re -piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ / Fire pit Boiler Stove/Range/Oven 10c I Dryer Water Heater 4 Fireplace/ Insert Other: Furnace Other: MEDICAL• (New, Relocated or re -piped) Qty Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: DEMOLITION Type of structure to be demolished: Square footage of structure to be demolished: AHERA Survey done? Y / N FPSC AA Case #: Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ GRADE/FILL/EXCAVATE Grading: Cut ZDO cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ No)P,— GENERAL PROVISIONS APPLICATIONS: Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. LICENSING: All contractors and subcontractors are required to be licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License.