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20161202140627.pdfDEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION 121 5`� Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 A Fax 425.771.0221 PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS PROJECT ADDRESS (Street, Suite #, City State, Zip): � W OA e700"o Parcel #: e® � iL0©60300 Subdivision/Lot #: Project Valuation: $ yCya �_ /�L 004A Lam_` I�b,Z B�vcic vc�v�pcc� Lcl 3 APPLICANT: /4 w `"rg164 C_ 7A 0,.5 H Phone: Fax: 4 z s- 5i 0-074 Address (Street, City, State, Zip): E-Mail Address: !�• i� 1�ox 'ZUi 3 I55-AOGA11 WA, '113 610104,1L !'�R�A PROPERTY OWNER: r.5 rAka r �L_ I_\0t: 0 Phone: e _ Fax: ZC(Z,,m 5 701 -�5! 6 State, Address (Street, City, , Zip): E-Mail Address: ` A G 1O M 0II1 I,) � WA LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: I CONTRACTOR:* q Phone: Fax: '25-1,C%U..0115 Address (Street, City, State, Zip): E-Mail Address: License #/Exp. Date: *Contractor must have a valid City of Edmonds business license prior to0A0'' 1i 0o, O 6ir VWAAte siness License #/Exp. Date: doing work in the City. Contact the City Clerk's Office at 425.775.2525 02'3L5b 0 ZGI DETAIL THE SCOPE OF WORK: t t..�..........1 .�....��..........i� A C�>............ PROPOSED NEWSQUARE FOOTAGE FOR THIS PROJECT: Basement: , ... uu _ __,,, uu___.... --.Sq. ft. Select Basement T e: Finished IJ Unfinished lit Floor: s , ft, Gara e/Car ort: -sq. ft. 27 Floor: s . ft. Deck/Cvrd Porch/Patio: -sq. ft. Bedrooms # Full-3/4 Bath # Half -Bath # Other: s . ft. Fire Sprinklers: Yes No RetainingWall: Yes No Grading: Cut cu. yds. Fill cu.yds. I Cut/Fill in Critical Area: Yes No I declare under penalty of perjury laws 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 I VA (-4 e 1 �ZA 1)E 0 m Owner ❑ Agent/Other 21/(S ecif Signature: �. m., , .,a �� . Date: FORM A LABuilding New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014 ov DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION FORM A s i 121 5th Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 Fax 425.771.0221 uipment Type r Appliance/Equipment Information (new and relocated)rnace Gas #Elec #__.-Other:- # BTUs: <100k_ >100k_ Locations) -- r Handler / VAV (circle selected) Gas #_ _Elec # Other: # CFM: <lOk,IT>lOk ,W..... Location(s), AC / Compressor / Boiler / Heat Pump / Gas # Elec #--.Other:, -- # BTUs: <100k, 100k-500k, 500k-1Mil Roof Top Unit HP: <3, 3-15, __.,_,_ r.15-30 Location(s) _ ,_ _� (circle selected) Hydronic Heating Gas #_Elec #_In -Floor _Wall Radiant,,, ......,_ Boiler BTUs._ Location. Exhaust Fans (single Bath #_Laundry # duct) _Kitchen �Otl,er: ._._........ .-.-.---.._ --.# „_,wwww, I Fireplace Gas #—Elec #mrITITIT f)tha t . # Location(s) Dryer Duct Appliance Type Appliance/Equipment Information (new and relocated) Total # AC Unit BTUs: Location(s):, _.— Furnace BTUs: Location(s):._..... .............. ._-- „ wvvv wv Water Heater BTUs: __ ,,....,W _u_ Location(s): ............... Boiler BTUs: Location(s):._._.__ Other: BTUs: ------ Location(s)M'_....W......._W.._________....--.. Fireplace/Insert BTUs: .---_ Location(s)........... _ ... Stove/Range/Oven Dryer ................ Outdoor BBQ TOTAL OUTLETS Fixture Type (new and relocated) Total # Fixture Type (new and relocated) Total # Water Closet (Toilet) Pressure Reduction Valve/Pressure Regulator Sink (kitchen, laundry, lavatory, bar, eye wash, etc.) Water Service Line Tub/Shower Drinking Fountain Dishwasher Clothes Washer Hose Bib Backflow Prevention Device (e.g. xBPA, DCDA, AVB) Water Heater Tankless? Yes No Hydronic Heat in: Floor 0 Wall Floor Draml loor Sink er: [­­g water supply (for water/ice dispenser) ....................................Refrigerator er: FORM A LABuilding New Folder 201000NE & x-ferred to L Building -New drive\Form A2014.docx Updated: 1/17/2014