20170310143720.pdfJ v DEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
6S.t l K�o 121 5`h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 Q Fax 425.771.0221
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #. City State, Zip):
Roo"
Parcel #:
1-1-13'l AVE 5 COM0145 wq
Subdivision/Lot #:
Project Valuation: $ WOO
APPLICANT:
CtNThS F lRt FRoTaEc�bN
Phone:
? i �5Z Iq b2
Fax:
?�3 �ri2 z j
Address Street, City, State, Zip):
5S20 Wt'Sr N -*DI 11 9 WI
E-Mail Address:
rNq I.EJ !� inrr ,con�i
PROPERTY OWNER:
J Mcb,1 mess
Phone:
4Z5 --v7& 90 Y5
Fax:
Address Street, City, State, Zip):
l* .MPL40F ST eP40XOS W19 4soyp
E-Mail Address:
JW t Call�intpSPAMrb.cu�vl
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
C�{V�iO�S V404E YiL0Tcc-=0N
Phone:
?a5381521111.7-
Fax:
Address (Street, City, State, Zip):
332e WEST v H Q #DZ it >r{+, " twift I
E-Mail Address
H4LEJ A G *M*S. c oA4
WAState License NEW. Date:
` 14V 03 X
*Contractor must have a valid City of Edmonds business license prior to
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: Eµ ��R�C ppk11� 1 " p�NEI INOP
P*N4Et. X,044§1 0 AN C_ #'ad-J ?r w1 S %DE of B-06
PROPOSED NEWSQUARE FOOTAGE FOR THIS
PROJECT:
1st Floor: s . ft.
2Id Floor: —sq. ft.
3rd Floor: s . ft.
Basement: —sq. ft.
Garage: s . ft.
Deck/Cvrd Porch: —sq. ft.
Other: s . ft.
Retaining Wall: Yesl
I No
Fire Sprinklers: Yes No
Occupancy Grou (s):
Occu ant 11oad(s):
Type(s) of Construction:
Grading: Cut cu. ds. Fill cu. ds.
Cut/Fill in Critical Area: Yes
I J
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: .left oPt%.s Owner ❑ Agent/Other VI (specify):
Signature: Date: 3 -10 1-
FORME L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form E 2014.docx Updated: 1/17/2014