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Building Permit Applications (2)'0c. 1 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.pov. 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 call425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 30o ro ��cU , S Parcel: 0 O -1 -,z7) !"Zl Z2_0 19 0D Lot /Unit/Suite #: Subdivision: PROPERTY OWNNEt1R: Name: CA9-tG Pli,u P-1 NCB Mailing Address: � 04 HA l.15 St City/State/Zip: �D M () Nt)S w A e W_0 Phone #: ? -O() — do ` 2-2-=�- Email: 42Q.V\h.Ri Ili 14 OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes>�N`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 /O CONTACT INFORMATION: Name of Applicant: (pAIM MUt-I,EP_/ Mailing Address: 7 ZO�1, GP_1 i1bN li,40 D AQ5 N City/State/Zips,r� : �F IM -'F, Wq�C �8103 Phone #: Ly V D? �2_ — Z 1 t'111^A E-mail: t:ilq — C� 1Ct�VH GENERAL CONTRACTOR: (If different from applicant) General Contractor: C-0 c C) N STp_V Gi ) o N Mailing Address: 704 k—NAP`- ->T City/State/Zip: 'FDVk O WbS WA M020 Phone #: ZD`D — LJ 1 — "91 E-mail: , Q� owcA. STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: GC. c i-T c o 0 55 MC- 9/Z1�2-1 TYPE OF PERMIT (Provide Details on Page 2) ❑ Accessory Structure/ Detached Garage El Addition ❑ Demolition ❑ Mechanical rXNevv 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: N?",, 1st Floor, sq ft: 2nd Floor, sq ft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: 3 Vd FL?, Finished ❑ Unfinished ❑ 210 _ (o1Z 1 C)IF `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: l�T� F�S �-t—� �_ 1 N.rw:l Signature: 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 BTUs Gas / Elec / Other Qty A/C Unit /Compressor Air Handler /VAV Boiler Dryer Duct Exhaust Fans i 1..E )CJ Fireplace Furnace Heat Pump Unit A Q Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: PLUMBING FIXTURE COUNTS (New, .. re -piped) Qty Clothes Washer Tub/ Showers Dishwasher ( Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink Refrigerator Water Supply Hose Bibs 2- Water Heater - Tankless -or N Hydronic Heat Water Service Line Sinks Other: + Toilets 3 Other: Qty BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven loom k Dryer Water Heater Fireplace/ Insert Other: Furnace Other: Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: Type of structure to be demolished: ') Square footage of structure to be demolished: AHERA Survey done? Y / N PSCAA Case >f: 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 ❑ Qty 2 GRAIL/1-ILL/ LALATA I It Grading: Cut JOQ cubic yards Fill Z"1 cubic yards I Cut / Fill in Critical Area: Yes ❑ Ng IGENERAL PROVISIONS I APPLICATIONS: Applications are valid for a maximum of 1 year. I 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. Inc. 1 x4- 11 15tl 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.Rov. 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 D 2- b+lk /AA"-U E S Parcel: 0O!� 2-1 22o 19 DID Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: (A9-lS p lcli`,Fp-1 NCB Mailing Address: � 04 HAP L5 Sit City/State/Zip: Phone #:�� c� �- Email: r—V I�J CNW-9 A CD' hp "" OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes Ko 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: �, rr lbpA NMP-IV Name of Applicant: �pAIM MULC -//hFcff ffax Mailing Address: 7 ZO! GP-5bN WOIO `D AV6 N City/State/Zip: jEA"ML� i Its 1�C R ffV Phone #: �� ?;?2- — � `'I E-mail: b>C e Qa - 0-r �1^ 1` c%m-- GENERAL CONTRACTOR: (If different from applicant) General Contractor: C-0 C O N STP-V a-10 N Mailing Address: 704 "%PLF671 ST City/State/Zip: �;IbK O WPS W 1e-�Q Phone #: Z06 - 4�-1 — 122--� E-mail: QM owgA STATE UBI M O CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: GC Lt1P C o 0 55 Mc. �1/ZI�2.1 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 FOOTAGE FOR THIS APPLICATION Basement sq ft: Iv 711� Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2+� 2nd Floor, sq ft: 8�Z FGarage/Carport:, sq ft: boo Covered Porch/Patio: / sq ft: 3 � 8 ( PROJECT• C-ONST?-V C-T 1 D N w � 2:Ee-Q LOT U ►y � Z CIF 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: CiA US T 1 C-1! �— N•� Signature: ,� Dat GENERAL COMMERCIAL DATA Occupancy Group(s): S-Z Occupant Load(s): Type(s) of Construction: V—N Fire Sprinklers: Yes ❑ NA� 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 rn�yyr�� Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE Qty Qty Clothes Washer 1 Tub/ Showers Z Dishwasher Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve I Floor Drain/Sink Refrigerator Water Supply I Hose Bibs I Water Heater - Tankless? Y or N 1 Hydronic Heat Water Service Line I Sinks 4- Other: Toilets 3 Other: GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven ( fCOD 1 Dryer Water Heater Fireplace/ Insert Other: [Furnace MEDICAL• (New, Other: Relocated or re -piped) Qty QtY Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum DEMOLITION Other: Type of structure to be demolished: S��.r MAAe Square footage of structure to be demolished: 8bb AHERA Survey done?®N PSCAA Case q: LO) Critical Areas Determination: Study Required ❑ Conditional Waiver l-1 Waiver ❑ Fill in Place ❑ Fill Material: Removal ❑ Size of Tank (Gallons) Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ Grading: Cut L-O0 cubic yards Fill L_) cubic yards Cut / Fill in Critical Area: Yes ❑ NOX 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. ll� It 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 call425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where theworkis taking place) Job Site Address: 3 b0A A,U E S Parcel: 0 04?.--, ZZO 19 0O Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: CIA 12-1s P lU P.-1 NCB Mailing Address: a0! MAP L-5 ST City/State/Zip: rp lm O NtDS , w A I U0 Phone #: 2-0b -- 4 5?3 - 1.2__=L�� c p�- Email: Gh W-9- � F� �' � �" OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes >9 [ 0 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 b QA NMP-Si Name of Applicant: GhLu Mailing Address: 7 Zo! 6P-Fi1bN pd0 � AVE N City/State/Zip: SE%ti�� i��C�t W 103 Phone #: � V ` ��8(,Z — E-mail: oOCbL,c� cba - ax-c_�n. ow GENERAL CONTRACTOR: (If different from applicant) General Contractor: C-0 (.o N STP.VC T-1 o K3 Mailing Address: 704 A`R� S1 t� City/State/Zip: ��KC)NOS WIAK M02y Phone #: Z0 (o — 4 1 22 7:� E-mail: QftO � STATE UBI #: O CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: GC LtIP c o 0 55 Mc. UZI/44- 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 ❑ 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 Basement sq ft: FOOTAGE FOR THIS APPLICATION Finished ❑ Unfinished ❑ 1st Floor, sq ft: 919 2nd Floor, sq ft: 5 C) Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT• 8 �J�hl LONSTV.ULT ION 0� S ►� EP o LOT LI 1�1 2% oIF 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- N Signature: Dat,� Occupancy Group(s): K- —b Occupant Load(s): Type(s) of Construction: V -- N Fire Sprinklers: Yes ❑ NoX_ 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 r( � Exhaust Fans Fireplace Furnace Heat Pump Unit Hydronic Heating Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: Qty QtY Clothes Washer ' Tub/ Showers Dishwasher I Backflow Device (RPBA, DCDA, AVB) Drinking Fountain Pressure Reduction/ Regulator Valve Floor Drain/Sink Refrigerator Water Supply I Hose Bibs Z Water Heater Tankiess? Y or N Water Service Line Hydronic Heat Sinks 194— Other: Toilets 3 Other: CONNECTION COUNTS BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven ( JQc I Dryer Water Heater 20 1000 Fireplace/ Insert Other: Furnace Other: MEDICAL• Relocated . • .•• Qty Qty Carbon Dioxide Nitrous Oxide Helium Oxygen Medical Air Other: Medical - Surgical Vacuum Other: DEMOLITION Type of structure to be demolished: I) Ik 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 2-00 cubic yards Fill 4J cubic yards Cut / Fill in Critical Area: Yes ❑ No)Si,— 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.