BLD20160590.pdf.4,
U' I DEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
t' 1� 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-FAMILYBUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: 00 3 9 I y 0000
`, 0 1
14
9R04 Gdn.orIs l
av
Subdivision/Lot #:
Project Valuation: $
APPLICANT:
Lob�9 Rao ;A ,
Phone: Fax:
4ts-»s-zZ76
Address (Street, City, State, Zip).
8037 E -Mail Address:
PROPERTY OWNER:
w,ndso� P�I�
Phone: Fax:
Es-+aa�s- y�-�rss-�n
Address (Street,vv, k- Dr Sot Zpo f,3dllwa WA Ian Cb
( City, State, Gip): 98005 E -Mail Address: 1-WAII1 �� $ pv�n, rh
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip);
E -Mail Address:
CONTRACTOR:*
Lo d
Phone:Fax:
wzs -7-76-1:06
Address (Street, City, State, Zip).
Sao® 1; 8$ °� s SCALA
37 E -Mail Address
L ,w� WA rhaik bg Ld U ,00 .'-on^
I ii WA State License #/Exp. te:
*Contractor must have a valid City of Edmonds business license prior to L 0 g G9 94 ? 7 Z K 8
doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
R 019'X09
0 9 1 z 6
�t 1 1i
1nJT o.1
119'X
9 o ,k d o R 0-4 Q.�
DETAIL SCOPE OF WORK:
—__ -
PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
Basement: sq. ft
Garage: sq, ft,
1" Floor: sq. ft.
Deck: sq. ft.
2 nd Floor: sq. ft
Other: sq. ft.
P Floor: sq. ft,
Occu aney: Occupancy Load:
Retaining Wall: ❑Yes ❑ No
Grading: cyds. I Type of Construction:'"
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: MNfI '01-
❑ Owner )q Agent/Other (specify), COnafA��O/
Signature:
Date: 6
FORME LABuilding New Folder 2010\DONE & x-ferred to L -Building -New drive\Form E.doc Updated: 10/2011