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City of Edmonds
Permit Application Form
Form A
Brief Description: REPLACE 1 BEDROOM WINDOW. NO SIZE/STRUCTURAL CHANGES,
Site Address: 9106 216th St SW Suite #
Sno County Tax Account Parcel M OOS61000001501
Business/Tenant Name (if applicable):
Mailing Address: 9106 216th St SW
City: EDMONDS State: WA ZiP:
98026
Phone: ( ) 561-714-4453 FAX: () E-Mall:
Mailing Address:
City: RENTON
Phone: ()
State: WA zip: 98057
800-381-5699 FAX: ( )
E-Mail;
State License Number, HOMED**972RQ Exp: Date: 2/3/17 City Business License No: 021369
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Fill out the following information if "Other'.
Name & Mailing Address: Al K AID LN—O TH T I IRP .IT _ T. SUE—_
EVERETT WA 98208
City; hate:.„ Zip;
Phone: ()360-945-2787
ABC; () E-Mall:
888-400-0383 NAIDA@NWPERMIT.COM
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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 1 BEDROOM WINDOW. NO SIZE/STRUCTURAL CHANGES.
L:ITEMPIBUILDINGIWE:Bchecklists\$FR.C.OMM.APP.doc9/13/2006 3