BLD2021-0261+City_Application+2.12.2021_11.06.19_PM+2046860.11c. Is`),
BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.aov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildinapermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 721 Maple St.
Parcel: 00434208903300
Lot /Unit/Suite #: 89 Subdivision: 33,E 35
BUSINESS OR PROPERTY OWNER:
Name. Steve Gerhardt
Mailing Address: 721 Maple St.
City/State/Zip: Edmonds, WA 98020
Phone #: 425.478.3330
Email: scoutguy@comcast.net
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes ❑ No
I own, reside in, or will reside in the completed structure. This
installation is being made on pKexcha
rty that ow which is t
intended for sale, lease, re ac rding
18.27.090. `y
Owner Signature:
APPLICANT / CONTACT IN FOR ATION:
Name of Applicant: Steve Gerhardt
Mailing Address: 721 Maple St.
City/State/Zip: Edmonds, WA 98020
Phone #: 425.478.3330
E-mail: scoutguy@comcast.net
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:_
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Office Use Only
(ProvideTYPE OF PERMIT
Details ..-
Accessory Structure/
Addition
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
❑ Remodel
New Commercial/Mixed Use
Re -Roof
Signs
❑ Tank
Tenant Improvement
❑ Other
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: 3,000
PKOFOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sgft: Finished❑ Unfinished❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
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I certify that the information I have provided on this form/application 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 the City of
Edmonds. 1,.
Print Name: Steve har "',��—
I
Signature: Date 2-12-2021
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