BLD2020-1153+City_Application+10.27.2020_2.03.12_PMBJlしDiNG PERMIT
APPしICATION
DeveIopmen† §ervice§
BuiIding Division
121 5†h Ave N / Edmonds, WA?8O2O
425.771.02ま0
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」OBSITEINFORMATiON/しOCAT10N:(Whe「etheworkistakingpIace)
」obSiteAddress:1882480THAVEW
Parcei:OO4816OOlOO300
しOt/Unit/Suite♯: Subdivision:
BUSINESSORPROPERTYOWNER:
Name:MODUSPROPER丁YLLC
MaiiingAddress:3225T…eCreekBIvd#1653 city/State/Zip:DALLAS’TX75219
ph。ne#:(425)457-0298
Email:SteVeghio@gmaii.com
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Iown,reSidein,OrW紺resideinthecompIetedstructure,This
insta=ationisbeingmadeonpropertythatIownwhichisnot
intendedforsaie,lease,rent,OreXChangeaccordingtoRCW
18.27.090. 。wn。.Signa,u嶋:±zZ三越と/易しくA多> ∠/
APPしiCANT/CONTACTINFORMATION:
NameofAppIicant:K「uege「K「a冊ngLLC Ma冊gAdd「ess:2290158thAve・W"
City/State/Zip:MountIakeTe「「ace,WA98O43 phone#‥206-819-2710
E_ma出 greg@kruegerkraftng.com
GENERAしCONTRACTOR:(ifdifferentfromappiicant)
GeneralContractor:J&ArtContracto「sLLC
Ma冊gAddress:160OINE6thst city/State/Zip:BeIIevue’WA980O8
phone♯:206538-1419
E_mail:jfiua「ez99@yahoo.com
s丁A丁各U馴♯:603180200
ciTYOFEDMONDSBUSINESSLICENSE#:16822235
WASTAT各CONTRAC丁ORし&i榊(CCB)&EXPIRATIONDATE:
JAR丁CAC83OC7
Accessory Structure/
Detached Garage
DemoIition
New SingIe FamiIy/DupIex
Fire SprinkIer
New Commercial/Mixed Use
Tenant improvement
Remodel Perm柵fee§ are based on:
The vaiue of †he work performed. indica†e †he value (rounded †o
†he neares† d01iar) of ail equipmen†. ma†eriais, labor. overhead,
and †he p「O硝for †he wo「kindica†ed on冊S aPPiica†ion.
VaIua†ion: 500OO
B∂Sement Sq ft: Finished団unfinished□
1st FIoor, Sq ft:
2nd FIoor, Sqft:
Garage/Carport:, Sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: 2 #of NEW Bathrooms: 1
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I cer寄fy thatthe info「matうon l have provided on this fom/application is true,
correct and compiete. and that l am the propertY OWner Or duly authorized
agent of the property owne「 to submit a permit appiication to the Citγ Of
師ntName: G/宅を6 K/孔/乞多G々
Signature: