20170921115816.pdfDEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
121 5h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 9 Fax 425.771.0221
PLEASE REFER TO iI?P COMMEREVAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
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PROZqr ADDRE4.S a e,
.,�treet, guite #, Cit St t Z*P)' I�Lo
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Parcel #:
Subdivision/Lot #:
Project Valuation: $
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APPLICANT:
LA61 Ruo'G%j
Phone:
4LS -'7-7'; -t'Z-7 6
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Address City, Stai'e, Zip): J
kth 5VAE-A IS%". s4.
E-Mg� Addres
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—Phone:
PROPERTY OWNER: OV Z) 7
Address (Street, City, State, Zip):
LENDING AGENCY:
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E-Mail Address:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* Lv�slj Q& #411
Phone:
Fax:
Address (Street, City, State, Zy): \J
E-Mail Address
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
DETAIL TIM SCOPE OF WORK: roo-C kw/ TH S) 69JL�, &0-4044"�-
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PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
I st Floor: ft.
2 Floor: sq. ft.
3.. Floor:
Basement: _s ft,
Garage: sq. ft.
Deck/Cvrd Porch: —sq. ft.
I
Other: iFf
Rctaining Wall: YesD
Nol
11
Fire Sprinkleis: YesF 1 Nol
I
Occupancy Group(s):
Occupant Load(s):
Type(s) of Construction:
Grading: Cut _cu.yds. Fill _____cu.yds. I
Cut/Fill in Critical Area: Yes
D
NoE:l
Ideclare underpenalty ofperjury laws thatthe information Ihaveprovided on this formlapplication 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. AIOAA� Owner E] Agcnt/Other L�j (specify):
Print Name: _—RIe5— Date:
Signature:
FAIM
FORME LAB ui Idi ng New Fo [der 201 O\DONE & x-ferred to LA uilding-New dri ve\Form E 2014.docx Updated: 1/17/2014
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Edgewood Owner's Association
111 0-5th Avenue S
Edmonds, WA 98020
City of Edmonds,
We, the owners and board members of Edgewood Condominium authorize
Loberg Roofing to tear down the old roof and install of a new roof.
GeorgeWangen,
Ores ��t
Edgewood Owners Association
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