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Building-permit-applications_8711_Talbot`4c. I g9" BUILDING PERMIT APPLICATION 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 coil 425.77I-0220 to schedule an intake oppolntmenr? JOB SITE INFORMATION/LOCATION: (Where the work Is taking place) Job Site Address: Parcel: �g 44) 0 c [ IS0 0 Lot /1Jnit/Su ite #: Subdivision: PROPERTY OWNER, Name: 5 e w+w Mailing Address: 11 1a 6:--F- k,>t^k City/State/Zip: E d4lalkill VnJA—W 2 A Phone #: 2 0 (�4 Phi ° •� Email: 1 OWNER INSTALLATION: *If yes, read and sign* Will work be performed by the property owner? ❑ Yes Ei 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 INFO R ATION: Name of Applicant: V a,n Mailing Address: 9Z 11 74J b.-& le�.a City/State/Zip: Z Phone #: 'Za Z E-mail: pr,,rrr it �' ww _ r i,) lid GENERAL CONTRACTOR. (If different from applicant) General Contractor: IT 6+�clhrF Br� �-r�s C4ra,pil>�t ° _ Mailing Address: ngo City/StatetZip: S IB- Phone #: Z- oX D E-mail: CL ,L�171 STATEUBI#: CI— II - 147- CITY OF EDMONDS BUSINESS LICENSE #: NIA — t it i S WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE, Office Use Only ❑ Accessory Structure/ Detached Garage © Addition ❑ Demolition ❑ Mechanical ❑ New Single Family/ Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑ Signs ❑,Tank ❑Tenant Improvement M Other64tie- - ~gr'ES Remodel Permit fees are based on: The 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: Do a y. Basement sq ft: Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2nd Floor, sq ft: GarageXarport:, sq ft: Deck/covered Porch/Patio: Other sq ft 11 �� ii.U.�o t�utite t, ►�,tk 5 ►v in o.#'� ' 2 C i116� •aC I certify that the information I have provided on this formlappllcation 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: 5he.+14 Pam+ _ ��"