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bldg permit app - contractor info'nc. i 8g''' BUILDING PERMIT APPLICATION Permit#: Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: www.edmondswa.gov. PLEASE NOTE: Intake appointments are required for New Single Family Residences, Large Additions, ADU's, New Commercial, and Major Tenant improvement application submittals. If plans are prepared by a profession- al, electronic files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please call 425-771-0220 to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address:. %00 �, f / 4 [ , Parcel: lJ 0 :�Y9 0 % 20 Lot /Unit/Suite #: " Subdivision: PROPERTY OWNER. Name: SM & N�'lCn-e_ Mailing Address: Zoo q , City/state/Zip: Phone #:._YJ ��, r c{ 2 1 Email: �rl4a/ `!1 /Lj ej a o/ r,e r'r7 OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes Q 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, leas rent, or exchange according to RCW 18.27.090. � + Owner Signature: APPLICANT / CONTA IR(FORMMATNON: Name of Applicant:, Mailing Address: City/State/Zip: & (MM 0 V Phone #: E-mail: ;_/7Ir /71 L�'0 -iGP? GENERAL CONTRACTOR: (if `diffeerent from applicant) General Contractor: Jc l L , Alpo, Mailing Address:5%24 AQ2.EY se- City/State/Zip: Z'__0en2:t1 , L,A- aQjZUg Phone #: A 25 _75 O CD 31S_7 E-mail: \2 50— rV t S L �r0+McA-i `. c o M STATE UBI M CO C2 :; q % -- A 1 g CITY OF EDMONDS BUSINESS LICENSE #: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION ATE: 2S -7 9� 07- to I2 l TYPE OF PERMIT (Provide Details on Page 2) ED] Accessory Structure/ Detached Garage ❑ Addition © Demolition ❑ Mechanical 0 New Single Family / Duplex ❑ Plumbing I ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs 0 Tank ❑ Tenant Improvement ❑ Other 1 Remodel Permit tees are based on: j jThe value of the work performed. Indicate the value (rounded to { the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. valuation: t l ° CCU PROPOSED NEW SQUARE•r► a• THIS APPLICATION Basement sq ft: Finished ❑ Unfinished 0 1st Floor, sq ft: 2nd Floor, sgft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: Other sq ft: PROJECT DESCRIPTION rcl.0 G z"r i fI I i I I certify thatthe information I have provided on this form/application is true, correct and complete, and that I am the property owner or duly authorized j agent of the property owner to submit a permit application to the City of Edmonds. } Print Name j� 1 Signature: '"--^ Date? i � � Vies