24215 105TH PL W (2).PDFlill iiiiii
379
24215 105TH PL W
OV ED -Af Oq7q
CITYOF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
BUILDING APPLICATION ACCEPTANCE
Friday, November 21, 2008
This Application has been accepted by the City of Edmonds for review. More information and changes may be
required during this process. The review target date is: Tuesday, December 09,
Your City Contact is: THERESAUMBAUGH STr","EET FILE
Application Number: BLD20080974
Project Address: 24215 105TH PL W, EDMONDS
PROPERTYOWNER Al'I'LICANT
CIA YTON MILES CLAYTON MILES
24215 105TH PL W 24215 105TH PL W
EDMONDS, WA 98020 EDMONDS, WA 98020
206-542-9049 0% WIr r'%06-542-9049
b- IREET FILt
Work Description:
3 0 0 SF SHED, WORK DONE PRIO TO PERMIT ISS UA NCE.
Outs tanifing Items at Time of Submittal:
XMC)
"Pu 01V W, I.
EBY WACKNOWG THAT I HAVE READ THIS APP-L MCAN THAT TTH AFORM -IV RRECT
WV I V INS 0
AND THATI AM THEPROPERTY OWNER, OR THEDULY AUTHORIZED AGENTOFTHE PROPERTY OWNER TO
SUB TA BUILDING PERMITAPPLICATION TO THE CITY.
Z OYI-X
�4� ) 1V,,'1e-,5 v-1v v // -,-9 J— —
Z,*`SfGNATURE(6VV-NER O�&Z;ENT) PRINTNAME DATESIGNED
ilk,
STREET FILE
To view up to date information aboutyour application please visit the City of Edmonds Development Services
website at http.-11www.cLedmonds.wa.us.
City of Edmonds
Permit Application Form
Form A
A r 'bw Single Famil 14
Permi pplication fd,
Ej'N Y'
Interior Rembdel'.,' .0 Garag,e/Carpor-,t El P
F1 Fence n'Gradihg CA,
n Tenant Improvement/Change of U
F] Rockery/Retaining Wall
Other'(Specify) A Ilk, I 1i
Brief DescriptionA. ijy ILZ2��
Site Address:
Sno County Tax Account
BuiinessffenanMmeA
I . PROPERTYCWVER:
/ I
ec
OV ED -0
'7C.
M2
DATE: / / -
Suite #
Mailing Address:-, AJI
City- at !Zrci 2—
Phone:'(�Ld6_ :j� 41.2
49 F AW (f,4 '4 1v 7e; "V C
CONTRACTOR: OSame as- Property Owner 00ther (Name)
Mailing Address:
City: State: Zip:
Phone:
FAX: E-Mail:
State License Number: Exp: Date: City Business License No:
APPLICANTICONTACT.�" DSa Me� as PhDpefty 6wnev OSame as Contractor 00thet,
Fill out the following information if "Other".
Name & Mailing Address:
City: State: —Zip:
Phone: FAX: E-Mail:
L:\TEMP\BUILDINGkWEBchecklists\SFR.COMM.APP.dor-5/24/2007