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BLD20160581.pdfJn DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION �,rtl It 1215 1h Avenue N, Edmonds, WA 98020 Phone 425.771.0220 It Fax 425.771.0221 City of Edmonds PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMPITAL REQUIREMENTS PROJECT ADDRE S (Street, S ite #, City Stat , Zip): -t S C/191()-& Parcel #: A419 IG Zr, Si l e e S w E�e"o_e,r_� Subdivision/Lot #• • Project Valuation: $ 1 Zt fib© o� APPLICANT: ^� ��/r,n L(��Oe ✓ Pho e: � 5 T) _5- —4430 Fax: Address Street, City, State, Zip): E -Mail A dress, PROPERT OWNER: Phone: Fax: Mar Te_IIn Address (Street, City, State, Zip): gy 19 �w S 9201( E -Mail Address: f'0on/0 5e_11qj, o,-, 1-1-L� l��r►,o�,l MOtr-I-.•td1 LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E -Mail Address: CONTRACTOR:* n C-'eu.n P_P ).,II, (1 Phone- Fax: (-ZOD 3157_qy3® ^,e, r,��Ti,nw Address (Street, City, State, Zip - I 140-) A16- I ��A Spurr �; ,.e 9.P / r 5- E -M ''t Addre : r �.-f= Sin. v r� "a f., A-, C es 11A *Contractor must have a valid City of Edmonds business license prior to WA State License #/Ex . Date: 60L_0 OL-0 L_j _ 03 Z 4 /30 � Z_®1.1 doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date - _0 - biz I q 4 I i/ 3 1 /2-006 DETAIL THE SCOPE OF WORK: -t �� " i a rw _ , PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement: sq. ft. Select Basement Type: Finished Unfinished I" Floor: sq. ft. Garage/Carport: sq. ft. 2 Id Floor: sq. ft. Deck/Cvrd Porch/Patio: sq, ft, Bedrooms # Full -3/4 Bath # Half -Bath # Other: sq. ft. Fire Sprinklers: Yes No Retaining Wall: Yes 71 No Grading: Cut cu, yds. Fill cu.yds. I Cut/Fill in Critical Area: Yes 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:Owner W Agent/Other ❑ (specify): Signature: Date: Z 16 r FORM A LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form A2014.docx Updated: 1/17/2014