20160301154802.pdfCity of Edmonds
Permit Application Form
Form A
Brief Description: Replace 2 bedroom windows; no size/structural changes.
Site Address: 9012 236th St SW, C Edmonds Wa 98026 Suite #
Sno County Tax Account Parcel #: 00463300400103
Business/Tenant Name (if applicable):
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Mailing Address: POBOX77176
city: Seattle
Phone: ( 206-510-9985 FAX:
State:', Wa Zip: 98177
-Mail:
State License Number: HOMED**972RQ Exp: Date: 2/3/17 City Business License No: 013480
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Please provide a complete detailed written scope of work for the proposed
project.
Additions (additional square footage): Specify room use, floor level and square footage and
direction if applicable (i.e. 545 square foot master bedroom/bathroom addition on the second floor
with 140 square foot deck and 245 square foot kitchen addition on the main floor at south side of
house).
Remodels (interior renovations): Specify room uses and floor levels (i.e. combine bedrooms 1 and
2 on the main floor to create new master bedroom/bathroom; replace dining room sliding glass door
with new French doors, reconfigure kitchen with new island prep counter and install new gas fireplace
in the living room).
Replace 2 bedroom windows; no size/structural changes. Work Value: $1572.92
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