20160913160546.pdfEDA,
Q,
City of Edmonds
DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 It Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): 7,902C)
Parcel #:
Subdivision/Lot #:
Prqject Valuation: $
-4 ac),) -
APPLICANT:,
�'kL-1-VAA .
Phone: Fax:
9 -09'// ....... ...
Address (Street, City, State, Zip): 60/+
E -Mail Address:
1CM11 F-rc-e-aw-T /20 9P,,c4,4a
::S�_% o f e- L T_ Wk 9-0C.) r-.rr-J C,, e L)Aj
PROPERTY OWNER:
Phone: Fax.
M/*,r 1+ C ") Ft- trio rN&2,
Z5- - ?_
Address (Street, City, State, Zip): ZT 0 c-') 2 0
E -Mail Address:
2-312-1 P1 01
LENDING AGENCY:
Pho=
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:*
Phone: Fax:
?'-'G gS -o gy
Address (Street, City, State, Zip):itcp�®c�r/+
P- ail Address:
C, (0
WA State License p, Date:
*Contractor must have a valid City of Edmonds business license prior to
L% t r- A -i l I? eq L; 9 e I
City Business License #/Exp. Date:
doing work in the City. Contact the City Clerk's Office at 425.775.2525
DETAIL THE SCOPE OF WORK: 6, 1" 0 V C- C_n Cs T T tQ C S1 -1A tz f -o- /ZV,,
77/ U's e_-7 c- c- 7 Cx XS 7 Z-1 I'Fc,-j /a S // C,-4 7-1-) Z,4J . . ..... ....
..... . . .............. . ................................ . . ................. . . . ...... . . . . . ...... . . .... . . . ..................... . ....................... . . . . .
. .... ... . . . . . . ................ . . ................ ..... .............. .........
PROPOSED NEW S!92UARE FOOTAGE FOR THIS PROJECT:
Basement: sq. ft. Select Basement TXpe: Finished [j Unfinished Lj
......... .
1S`Floor: . . .... ft. GaraEe/Carport: ----
............ . .
2"' Floor:s . ft. Deck/Cvrd Porch/Patio: ft.
Bedrooms Full 3/4 Bath Half -Bath # Other: ft.
...................
Fire Sainklers: Yes No Retaininz Wall: Yes No
Grading: Cut -cu. yds. Fill --cu.yds. Cut/Fill in Critical Area: Yes 0 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 ant the property owner or duly authorized agent of the property owner to submit a permit application to
the City of Edmonds.
01
Print Name: Owner
—1 Agent/Other specify}; ... . . ......
.... .. ...... .. ;"7,
Signature: Date:
FORMA _ building New �,,oldci, 2010\DONE & x-ferred to L, -Building -New driveTorm A2014,docx Updated: 1/17/2014