20160606134738.pdfON0
City of Edmonds
DEVELOPMENT SERVICES
COMMERCIAL& MULTI -FAMILY BUILDING
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 2 Fax 425,771.0221
1 11
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
yjlttillD (,Street, , Suite- #,. it Statc, Zip): Parcel #:�.n5E S,
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idivision/Lot #: I Project Valuation: $
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Address (Street, City tate, Zip):
E -Mail Arlress:
PROPERTY OWNER:
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Phone: Fax:
Li2 '12a -256d
Address (Street, City, State, Zip): ,�
E -Mail Address:
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LENDING AGENCY: 1,J
Phone:
Fax
Address (Street, City, State, Zip):"
E -Mail Address:
CONTRACTOR:*
Phone:
Fax:
Addross (Strcet„ City,, State,, Zile):
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E -Mail Address
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WA`State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
All "e
doing work in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Exp. Date:
DETAIL E; SCOPE OF V I
PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
1 st Floor: s . ft. 2"' Floor: .. ,
sq. ft. 3` Floor: _s. ft,
Basement: .. m..,,. _._s . ft. Gara e: mITIT �
s , ft. _ Deck/Cvrd Porch: rv,rv,rv,ry sq. ft.
Other: _—,sq. ft. etrtinin & Wall: Yes
No Fire S rinklers: Yes No
Occu anc` Grou (s): Occu ant Load(s):.ry ....._..
....._ Type(s) of Construction:
Gradini: Cut cu. ds, Fill cu. ds. I Cut/Fill in Critical Area: Yes LJ 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: Ay( f— - OwnerA ent/Oth�e�r (s, ecify): wW.._.._...mm
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Signature:�Date:
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FORM E L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form E 2014.docx Updated: 1/17/2014
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