FIR2020-0064+City_Application+7.7.2020_12.44.35_PMDEVELOPMENT SERVICES
RESIDENTIAL BUILDING PERMIT
APPLICATION
Fst. ta90 1215" Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 2 Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADD'eet $u�#� '�y St Zipa -
(X .1
Parcel #:
Subdivision/Lot #: f po-rLL.
/
Project Valuation: $
APPLICANT:
dvan
t j�
Phone:
92r, 34-T/,,
Fax:
Ad�ress (Street City, Sta Zip : ��
1822 lci�'i_ rFe /J Sno
Mail Address:
�trf.�vanct'd luAlh'
PROPE � OWiNER: t (�
Phone:
Fa
Address (Street, City, State, Zip):
E-Mail Address:
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-MaiI Address:
CONTRACTOR:* Ad
Pd-h U '
(y j �t
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
WA State License #/Exp. Date:
C; B si ss License #/Ex . a
t3' ,y� U 2 pt .
DETAIL THE SC PE__ O.lF! WO ` sLX
PROPOSED NEW SQUARE
FOOTAGE FOR THIS PROJECT:
Basement: sq. ft.
Select BasementType: Finished
LJ Unfinished
lst Floor, s . ft.
Garage/Carport: s . ft.
27Floor:
sq. ft.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms #_Full-3/4 Bath # Half -Bath #
Other: sq. ft.
Fire Sprinklers: Yes
No
LJ
Retaining Wall: Yes
No
Grading: Cut cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes
No
Ideclare underpenalty ofperjuty laws thatthe information) haveprovided on this form/applicadon is true, correctand
complete, and that I on the property owner or duly authorized agent of the property owner to submit a permit application to
the City of Edmonds, /^
Name: f W� U C ,n�r%
Print T Owner Q Agent(Other (specify):
Signature VDate: 7 "I—
FORM A LABuilding New Folder 201000NE & x-fe d to L-Building-New driveToml A2014.dorx Updated: 11170014