BLD2022-1113+PAPER APPLICATION+8.18.2022_12.55.00_PM+3059672BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mvbuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 22814 100th Ave. W. Edmonds, WA 98020
Parcel: 00610600300501
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: Pok Pok Thai kitchen
Mailing Address: 22814 100th Ave. W.
City/State/Zip: Edmonds, WA 98020
Phone #: 206 229 9376
Email: pokpokthaikitchen@gmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? Yes Fx-] 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 INFORMATION:
Name of Applicant: Tuan Nguyen (Spiral Signs & Awning)
Mailing Address: 3814 4th Ave So. #10
City/State/zip: Seattle WA 98134
Phone #: 206 240 1522
E-mail: spiralsigns@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: spiralsigns@gmail.com
Mailing Address: Advance Sign LLC
City/State/Zip: 1 37th st NW #C
Phone #: Auburn, WA 98001
E-mail: asl.tayor.j@gmail.com
STATE UBI #: 602.653.597
CITY OF EDMONDS BUSINESS LICENSE #: NR-026647
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
ADVANSL923DP Exp:3/23/24
Office Use Only
TYPE OF PERMIT (Provide
Accessory Structure/
Detached Garage
Details on Page 2)
Addition
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: $6,500
PROPOSED NEW SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq ft: Finished❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECT•
installation one LED illuminate channel letters on raceway
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 to the City of
Edmonds.
Print Name: Tuan Nguyen
Signature: Date 8/ 17/2022