BLD20161409.pdf0
' DEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
0
9' 121 5`s Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 A Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, Cit State, Zip): v
Parcel #:
O 164- ST SW
Subdivision/Lot #:
Project Valuation: $
APPLICANT —D-6 r I6-&� &f/L v r LR-
Phone: Fax:
Address (Street, City, State, Zip): S S
-L
E -Mail Address:
( U o S7a
PROPERTY OWNER: Stq &
Phone: Fax: It�+^J
Address (Street, City, State, Zip
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E -Mail Address:
S
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:* I� c
l
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
WA State License #/Exp. Date:
*Contractor must have a valid City of Edmonds business license prior to "I - / 7
doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
-
DETAIL THE SCOPE O�FWORK: %Y�4�-W_ lS 1(A_ r60 - ff n
� rn��t��
Uo
PROPOSED NEWSQUARE FOOTAGE FOR THIS PROJECT:
Basement: s . ft. Select Basement Type: Finished LJ Unfinished
Is'Floor: .--sq. ft. Garage/Carport: _ _ITITITITITITITITIT�sq. ft.
27 Floor: sq. ft. Deck/Cvrd Porch/Patio: sq. ft.
................
Bedrooms #� Full -3/4 Bath #,_ Half -Bath #,,,,,,,,,,,,,, Other: _______s . ft.
Fire Sprinklers: Yes No Retaining Wall: Yes No
Grading: Cut cu. Xds. Fill cu.yds. Cut/Fill in Critical Area: Yes LJ 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
` Sc ti Owner G f,
Print Name: 06 M ❑ AgenUOther ❑ (specify):
, _ ,
M � 8
Signature: ... Date:
FORM A LABuilding New Folder 2010WONE & x-ferred to L -Building -New driveTorm A2014.docx Updated: 1/17/2014