BLD2022-0857+Application+6.30.2022_12.54.50_PM+2964550CITY OF EDMONDS M BtaildingPermit.com
Special Use or Event Application #1167032 - Perrinville Roundtable Discussion
Applicant
First Name Last Name Company Name
Brad Shipley City of Edmonds
Number Street Apartment or Suite Number E-mail Address
121 5th Ave N brad.shipley(�D_edmondswa.gov
City State Zip Phone Number Extension
Edmonds WA 98020 (206) 225-3367
Contractor
Company Name
Number Street
City
State License Number
Project Location
State Zip
License Expiration Date UBI #
Number Street
18502 76TH AVE W
City Zip Code County Parcel Number
EDMONDS 98026 00434600010602
Associated Building Permit Number Tenant Name
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
Apartment or Suite Number
Phone Number Extension
E-mail Address
Floor Number Suite or Room Number
First Name Last Name or Company Name
104 N 84TH LLC
Number Street Apartment or Suite Number
8827 29TH AVE NW
City State Zip
SEATTLE WA 98117
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 6/30/2022 Submitted By: Brad Shipley
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CITY OF EDMONDS M BuildingPerrntt.com
Special Use or Event Application #1167032 - Perrinville Roundtable Discussion
Project Contact
Company Name: City of Edmonds
Name: Brad Shipley Email: brad.shipley@edmondswa.gov
Address: 121 5th Ave N Phone #: (206) 225-3367
Edmonds WA 98020
Project Type Activity Type Scope of Work
Any Project Type Special Use Outdoor Seating
Project Name: Perrinville Roundtable Discussion
The proposal is to host a city -led community discussion in a vacant building at the subject
Description of site. The event will run from 6-7:30 PM on the date of the event and is anticipated draw
Work: approximately 40 community members. The event will take place both indoors and outdoors,
weather permitting.
Project Details
Event Location
Private Property
Event Date
Begin Date 7/11/2022
End Date 7/11 /2022
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