pg 2 appliationGENERAL•
Occupancy Group(s):
DATA
Occupant Load(s):
Type(s) of Construction:
Fire Sp klers: Yes❑ No EL
WA STATE EN Y COD : If your project a ects t building envelope,
mechanica sy ems, nd/or lighting ou mu c plete the
appropriat WS fo S.
DEFERRED SU MITTAL - All com ercial buil ng perm s that will require
associate plumbing, mech ical, fire sp nkler, and or fire alarm
permits are applied for s arately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
MECHANICAL•COUNTS
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
place
E
ace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions if a Commercial Bldg)
Other:
FIXTURE
Qty
COUNTSPLUMBING Relocated or 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
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
+
Other:
Toilets
Other:
GAS/FUEL CONNECTION COUNTS (New, Relocated or re piped)
BTUs •
A/C Unit
Outdoor BBQ / Fire+pitBoiler
Stove/Range/Oven�
1 r
1�
Dryer
Water Heater
Fireplace/ Insert
a�
r
Other:
Furnace
Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re piped)
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical -Surgical Vacuum
Other:
Type of structure to be demolished: LbA.D &AQIN(I—
Square footage of structure to be demolished:
AHERA Survey done? Y❑/ NQ I PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver[]
Fill in Place ❑ Fill
Removal ❑ (� j / I, of Tank (Gallons)
Critical Areas Areas Determination:
Study Required Conditional Waiver Waiver
Grading: Cut
Fill cu
Cut / Fill in Critical Area:
yards
❑ No ❑
4PPLICATIONS: Applications are valid for a maximum of 1 year.
-SLHA Applications, 2 years.
.ICENSING: All contractors and subcontractors are required to be licensed
vith Washington State Department of Labor & Industries and have a
urrent City of Edmonds Business License.