APPLICATION.pdfDEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING r
PERMIT APPLICATION ED
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1215"' Avenue N, Edmonds, WA 98020 APR, 2017
City of Edmonds Phone 411,77 i .0220 Pay 4 5.771.0221 � E
71 SERVICES
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQ Ullll.M, u
PROJECT A01 RE,5'S (Str *e , Suite , City State, Parcel #:
Subdivision/Lot #: Project Valuation: $
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AP:VPC 1': Phone: Fax;
D214)11
,Adt - sysSf ee¢, City, State, Zi ): E-1' �il Address`
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PROPETY OWNER: Niom., Fax:
Address (Street, City, State, Zip): E -Mail Address:
LENDING AGENCY: Phone; Fax:
Address (Street, City, State, Zip): E -Mail Address:
COI's' R C"1"OR:* Phone: Fax:
® �I C°d
Atit ress (Street, City, State, Zip), ` 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 THE SCOPE OF WORK: �� �: _._ _ �_� -_..._ ��• .
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PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
1 st Floor:s , ft. aua. Floor: sc , ft. Floor: , s ft.
Basement: _ �st w ft. artt ; stn ft. Deck/Cvrd Porch: Sq` ft.
Other: s(, ft. Retaining Wall: Yes . No Fire Sprinklers. Yes No
file ul lane OrouLi(s ; Occ02tint Load s) : 17 ; e(s) of Construction:
Grading: Cut e(. tis. Fill � cu. ;uis. Cut/Fill in Critical Area: Yes LJ 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 EdttOnell W
Print Name: Zee 7"e Owner 1:1Agent/Other (specify):
Signature: Date: �..,.
FORM E LABuilding New Folder 2010\130NE & x-ferred to L Building -New drive\Form E 2014.docx Updated: 1/17/2014