FIR2020-0073+City_Application+8.4.2020_1.23.38_PMo
DEVELOPMENT SERVICES
s RESIDENTIAL BUILDING PERMIT
APPLICATION
Fst 1 gqo 12151h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 ft Fax 425.771.0221
PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBNPTTAL REQUIREMENTS
PROJECT ADDRESS (Street, Sui a #, Ci State, Zip),
k'&2 0 �t l
Parcel #:
Subdivision/Lot#: �11 of
Project Valuation: $
APPLICANT:
bU vk �Pl�
Phone:
92S 3 kS/UU
Fax:
Address (Street, Ci , S ate, Zip):
22 1 �Ih vt
E-Mail Address:
r . lzd wnlO/W J4 mb%k
PROPERTY OWNER: (� _�}
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
" v viah C¢ ki,
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:* �1
�f PILLm
I AO
Phone:
Fax:
Addre �(S ee City, Sltajp, ZipU): 1"
11L,UNXA
E-Mail Address:
*Contractor must have a valid City of Ed/nonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
State License #/Exp. Date:
PtnV01PTK3kR
City Business #/Exp. Date:
/License
DETAIL THE SCOPE OF WORK: K � 1 �! !/ry ae �t
0`1
PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT:
Basement: s . ft.
Select Basement Type: Finished Ll Unfinished LJ
I" Floor: s . ft.
Gaza e/Car ort: s . ft.
2" Floor: sq. ft.
Deck/Cvrd Porch/Patio: s . ft.
Bedrooms #_ Full-3/4 Bath # Half -Bath #
Other:
Fire 5 rinklefs: YesLA
No
Ll
Retaining Wall: Yes
Ll
No
Grading: Cut cu. yds. Fill cu.yds.
Cut/Fill in Critical Area: Yes LJ
No
❑
I declare underpenalty ofperjury laws that the information I have provided on this form/application is true, correct and
complete, and thatl ann theproperly owner or duly authorized agent of theproperly owner to submit apennit application to
the City ofEdnto`uddy.
Print Name: uih4 � (/ Owner ❑ Agentnt/Othe p1 (specify): t 2A NA-1
Signature: Date: 6 I I Zv
C t,�
Cam
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FORM A LA luilding New Folder 201000NE & x-furred to L-Building-New driveFona A2014.doez Updated: 1/17/2014