Loading...
APPLICATION,ric. 18`)" BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements go to: www.edmondswa.aov. To apply for permits, schedule inspections, or check application status go to: www.mvbuildinttpermit.com JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: Al�-1�7n/L1S Parcel: o7 903 %On Lot /Unit/Suite #: j Subdivision: 61K D79 A -00 BUSINESS OR PROPERTY OWNER: Name: &M i oN Mailing Address:' City/State/Zip: Phone#: Email: 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: _4is'/'7Z irS fJ�+�Uy Mailing Address: City/State/Zip: Phone #: E-mail: GENERAL CONTRACTOR: (If different from applicant) General Contractor: Mailing Address: City/State/Zip: Phone #: E-mail: STATE UBI #: CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: Office Use Only TYPE OF Details .. Accessory Structure/ Addition Detached Garage Demolition Mechanical New Single Family/Duplex Plumbing Fire Sprinkler Remodel New Commercial/Mixed Use Re -Roof Signs ❑ Tank Tenant Improvement ® Other D KeA 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 sci ft: Finished Unfinished 1st Floor, sci ft: 2nd Floor, sci ft: Garage/Carport:, sci ft: Deck/Covered Porch/Patio: # of NEW Bedrooms: # of NEW Bathrooms: PROJECTDESCRIPTION Ors 6t_ .rS 41?$ ,Q./=7- 1)A::�� i-SZ_ d �< rC?-T-A ) i� .5 r-A ` 4Z e n >n JC�:_ r— o s "ri U � L D �� 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: 1 re 'e2___A1 Signature. Date 7 �i GENERAL COMMERCIAL DATA Occupancy Group(s): Occupant Load(s): Type(s) of Construction: 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 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 Roof Top Unit (Provide eleva- tions if a Commercial Bldg) Other: COUNTSPLUMBING FIXTURE d or re piped) Qty 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: CONNECTION COUNTSd or re piped) BTUs Qty BTUs Qty A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: MEDICAL• 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❑ 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 GRADE/FILL/EXCAVATE Grading: Cut cubic yards Fill cubic yards Cut / Fill in Critical Area: Yes ❑ No ❑ GENERAL PROVISIONS APPLICATIONS: Applications are valid for a maximum of 1 year. ESLHA Applications, 2 years. LICENSING: All rontrartors-and subcontractors are required to he licensed with Washington State Department of Labor & Industries and have a current City of Edmonds Business License.