hot tub permit appBUILDING PERMIT
s APPLICATION
Development Services
Building Division
121 51h Ave N / Edmonds, WA 98020
fin, 1 toll 425.771.0220
For handouts, submhtal requirements go to: www.edmondswo.aov.
To apply for permits schedule inspections, or check application status
go to: www.mybulldinapermit.cam
JOB SITE INFORMATION/LOCATION: (Where the
work Is taking place)
Job Site Address:
0
Parcel:
Lot /Unit/Suite q: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: 0 (u, C, r\
Mailing Address: C� � 1 Sic>"ntf-b�Q_{- )cc��- 1�
City/State/Zip: Ecl ANpr1 c45 iw � C, C1 'Zo
Phone lt:
Email:
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes `�No
I own, reside in, or will reside in the completed structure. This
installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange according to RCW
18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: fy".' Lhc,-e k PN' �C' k\
Mailing Address: `(C>-' AJr vO
City/State/Zip: L_ lfl IJoc) L -6—
Phone
E-mail:
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: niu
Mailing Address:✓�'Z
City/State/Zip:
Phone ll:
E-mail: n •�
STATE UBI q: 1:
CITY OF EDMONDS BUSINESS LICENSE 8:
WA STATE CONTRACTOR L & 1 p: (CCB) & EXPIRATION DATE:
(\J LA:5 3 7y"--
1•rrn�,� M
TYPE OF PEIM17 (Provide
Accessory Structure/
Detached Garage
Details on Page 2)
Addition
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
Remodel
New Commercial/Mixed Use
Re -Roof
Signs
Tank
Tenant Improvement
Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollor) of oil equipment, materials, labor, overhead.
and the profit for the work indicated on this application.
VolucitiorK S )
PROPOSED NEW SQUARE•• •APPLICATION
Basement sq ft: Finished Unfinished
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
N of NEW Bedrooms: N of NEW Bathrooms:
PROJECT• t•
�O
DC-t-1� t-Vic <� + w b t,RNrr_
I certify 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 �r,(� 1
Print Name:/'��1 l\',C_Ka_tl_ 1 \ ' ` �\ AL'f_' `
Signature` /T GG LL>% Z Date =7L
LM