Application.pdfr
DEVELOPMENT SERVICES
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COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
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121 5"' Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220!k Fax 425.771.0221
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
21727 76th Ave West 00580700002701
Subdivision/Lot #: Project Valuation: $
500
APPLICANT: Phone: Fax:
Sheramie Odell 360-647-0110 ext.327
Address (Street, City, State, Zip): E -Mail Address:
1743 1st Ave S Seattle WA 98134 sodell@guardiansecurity.com
PROPERTY OWNER: Phone: Fax:
Healthcare Realty Services
Address (Street, City, State, Zip): E -Mail Address:
3310 West End Ave, Ste. 775 Nashivlle, TN 37203
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:.
CONTRACTOR:* Phone: Fax:
Guardian Security 360-647-0110 ext.327
Address (Street, City, State, Zip): E -Mail Address
1743 1 st Ave S Seattle WA 98134 sodell@guardiansecurity.com
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to GUARDSS233K5
doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
N RO18664
DETAIL THE SCOPE OF WORK: _ cP
Monitor takeover; Installing 1 AES Radio to monitor existing SK5820FA
PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
1st Floor: -sq. ft. 2" Floor: .... sq. ft. 3'dFloor: „ .. sq. ft.
M sq. ft.
Basement: �sq. ft. Garage: ..... --sq. " . ft. Deck/Cvrd Porch:
Other: sc . ft. Retaining Wall: Y=es Fire Sprinklers: Yes No
Occupancy Group(s): _ Occupant Load(s): _ Type(s) of Construction:
Grading: Cut cu.yds. Fill cu.yds. I Cut/Fill in Critical Area: Yes No LJ
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: Sheramie Odell Owner ❑ Agent/Other ❑ (specify):
Digitally signed by Sheramie
9/2017
Signature:
j" Odell Date: ........
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at.r:?QBi.ti4.1g08.70.45-070
FORME LABuilding New Folder 2010\DONE & x-ferred to LrBuilding-New drive\Form E 2014.doex Updated: 1/17/2014