BLD20161420.pdfDEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
.! ,sj l l %Z) 121 5`" Avenue N, Edmonds, WA 98020
City of Edmonds
Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PItOJECT ADDRESS (Street, S ite #, City State, Zip): Parcel #:
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SUFI divlsion&o #: Project Valuation: $ Gli 100
. 00
lY Phone: Fax: L�
A > I, SAN -775 _71
Sr. �ltt�� . �✓l
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Address (Street, Cit , ftbb U 4 , -State, Zi E -Mail Address:
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PROPERTY OWNER: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address.
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
CONTRACTOR:* Phone: Fax:
State
Address (Street, Ciy Zip): p) E -Mail Address
t
WA State license #/Exp . Date:
*Contractor must have a valid City of Edmonds business license prior to 4)0(7 ", 1007 4l �.wt._ �0 . 9-0n
doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Expo. late:
DETAIL THE SCOPE OF WORK:'+" wwiy,�( ITITmIT4 t W tr"+ -70
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PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
sq. ft.
1st Floor: sq. ft. 2 Floor: sq. ft. 3I Floor:
Basement: sq. ft. Garage: sq. ft. Deck/Cvrd Porch: sq. ft.
Other: sq. ft. Retaining Wall: Yes No Fire Sprinklers: Yes No LJ
Occupancy Group(s): _ Occupant Load(s): Tvve(s) of Construction:
Grading: Cut cu.yds. Fill cu.yds. Cut/Fill in Critical Area: Yes LJ No
I declare under penally 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: � Q� OwnerEl Agent/Other K (specify):
-
Signature: .._ ..... Date: ......... �.
I
FORM E LABuilding New Folder 2010\DONE & x-ferred to LrBuilding-New drive\Form E 2014.docx Updated: 1/17/2014