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application.,pcJ. ISy" BUIL11:::l'IIIP1IIG';, PIERMIT A III''III'LIIC'0,ATION Deveh:gzirnent Services 1;1r lidiirig (Division 1:21 :I'I'ht Ave N / Edl'1rl9:rnids, IAIA 98020 Qi! S.;r71.0220 f-oo handouts, submittal requirements, permit status aril inspection srhvdulfrig information go to: www.edmondswa.gov. Intake app:rintmeints are required tc+r ,"dew Single Family 1trsidences, Large Additions, ADIJ's, New Commercial, and 141gjor Tenant Irnproverent application subrnittafs. If plans are prepared by a profession- al, efect:ronic files are requ :,Ced in r3cldition to the hard capies, Please bring electronic files on a flash drive ar coordinate for electronic. transfer. ,F114.trse co,11425-771-0220 do s h edvile a h intake appoi.rtd ti ier ntl 1431E6 5111'IE: IINFORMATIOPI,FII.(:111.'A7!'IIO RI: (Where the inncirk is talking place) .I,:ab'.;ii:e Address: Z'KX...._l_C3 24 Ii:trcel; .s'z�.�...1�.._.0—__-.. . ................. Lot /I.)nit/Su ite #: _......... ..... __ Subdivision: I:111,f,)PERT1( OWNER: i Narne: _. D _ I. C..1.........._.__.. iVlailing Address:rnr C::fty/`.sate/tip:.L4?iC�liLc (11 11 lrl,ane It:Q2c�c�..C_..LQ_�.. `L(' a Email:..�4L ��...�� _.rr►����..__..... ___ I::LVWNIEFI, INSTALLATION,: "If yes, read and sign* 'chill work be performccad I:aytl•ie oroperty owner'? ❑ Yes Z No I cawn, aside in, or will re!:side in the completed structure, This installation is being mach? c:in property that I own ,ohich is riot intended for sale, lease, rent, car exchange accorcling, to Rf.:W C'w ner ::signature: ____........ ..... __...._.__� ............... i%IP'I:'LICr10IT / CONTACT 1111111F11' 111NIATION: Name afApplicant:__............... _._....._._�__ N'lailing Address: QJl.i,�....f��..........___...._..__� / (..ttyJ':,tate/zip:till.1.ZQ[J1d1_—/....._.LP._._ Phon r:: li`: 0& 41 G�4L �" _©.L�..L���_ . 1:iilE:l'rIER.I'6L CONTRACTOFI.: (II•f di-H� rc: nt from aapplir.:i:unil) (ieneral Contractor: N'failing Address: 20 .._._C (Ity/!:,tote/zip: lZ�%il�xa _....... y . Phorle It': _ �" � j5 _ '7 3 IE: • rr•rr it : �_t4:�LZ._C.C'-..,f�.....�-�.it.>�c' ►(.C..n�..�....��.,P�i__.....� CITY OF EDMONDS BI„ISsll'dESS LICENSE #: _,_,_........ ..... 'II1JA, s'irA,TE CON'TRAC 4:DI1: I. fk I H: (CCB) & EXPIIlu "I'IION DATE: Perrnit h-: Imo, LIP 2-0 I q — I .i'c,ccee:si:,ry Structure/ Detached Garage C:I Demolition 4FNI v::;ing;leFamily/ Duplex hire Sprinkler New C:ainmercial/ Mime:!d LISe ::::I Signs Irnprovement Las'on Pa 11 Addition 17 Mechanical 1::7 Plumbing 11 Remodel El Re -Roof El Tank 11 Other li a nnocl el Permit fees aira:r lbaasenel oin: fhe vaI1.,e of the work perf::nrned. Incit: ate the valu(n! (rauna•iad to t",0 Hearst dollar) of all e:;:l.;il:;mc3rrt, materials, labc�.1•errc:l, cind the profit for the v✓ork inch co fed on this applicci 1'c:nrt. 6raiuo-Elo n: 8;i.,seime h1: sq ft: Finished C7 Unfinf ,hr:!d C:1 I.:: t floor, sq ft: 2 2 L& ..........._.__....- -- - ------�...................-- '.nd Floor, sail ft: 3 �7 J ............----- -- - --- -- ................_._.. Caarage/Carport:, sq ft: SO [:,eck/C:overed Porch/Patio: 01 her sq it: ..��r►s� _..�L........n.I�.a._...�� ......v.�_, _._lam_ ._..A7...0................. ____ .__........ I ........... - .......... _ I r.erdfy ghat the information I h i� ve pr<a.oided on this farm/appli::atrion is true, .:orrect and complete, and that: I tun the p•cperty owner or di.dy authori.ted al;en t of the property owner to :::ihimi1: ,a permit application t.:) that City of 1aarrnonds. �� --}}/ h'Iririt Nrarne': .............1_N...1�...._..._.............. ,._....... _._.._ :!i i;g;nat:uire: Dat.r:: ,,,,,,%I .... % --J