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APPLICATION�y of EQAj BUILDING PERMIT Y ° APPLICATION Permit[ Development Services Building Division 121 51h Ave N / Edmonds, WA 98020 Inc 1 gal) 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: www.edmondswa.gov. PLEASE NOTE: Intake appointments are required for New Single Family Residences, Large Additions, ADU's, New Commercial, and Major Tenant Improvement application submittals. If plans are prepared by a profession- al, electronic files are requested in addition to the hard copies. Please bring electronic files on a flash drive or coordinate for electronic transfer. Please calf 425-771-022D to schedule an intake appointment! JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: gaao CDSW30- De . Parcel: 0004 6600001D50! Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: 1A)i l[ icl msorl 010rdas Mailing Address: gaw CQ`scade De. City/State/Zip: / EdYl o n dS , ✓ A Q9W 0 s Phone #: (�l � �aQ6) 85.3-5-qu1 Email: chL4ck �1"nt )ass , can OWNER INSTALLATION: 'If yes, read and sign* Will work be performed by the property owner? N Yes ❑ 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 28.27.090. Owner Signature: APPLICANT / CONTACT INFORMATION: Name of Applicant: ioHn -ZWb&1& Mailing Address: Alaos 3q-111 -fUe w City/State/Zip M - /Z! g803� Phone #: �a 36l 77� E-mail: I l`1 e l DCO IZ& E (�Pto ..— GENERAL CONTRACTOR: (If different fromya�pplliicant General Contractor: p l I I I-1if o Mailing Address::1 City/State/Zi U y� t I DIA fA I Phone #: 88 $ d5 E-mail: I7 i STATE UBI #: H DL CGC 95L4 M1 Of" CITY OF EDMONDS BUSINESS LICENSE #: 62139(.53 -Xi- WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: oi-ai-ao,�G TYPE OF ❑ Accessory Structure/ Detached Garage ❑ Addition ❑ Demolition ❑ Mechanical ❑ New Single Family/ Duplex ❑ Plumbing ❑ Fire Sprinkler ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof ❑Signs ❑ Tank ❑ Tenant Improvement ❑ Other Berl Remodel Permit fees ore based on: The value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the pratit for me wont inaicatea on TNS application. fi s.Cnr'� valuation• PROPOSEDNEW SQUARE Basement sq ft: FOOTAGEFOR Finished ❑ Unfinished ❑ 1st Floor, sq ft: 2nd Floor, sqft: Garage/Carport:, sq ft: Deck/Covered Porch/Patio: 1'54 SI- Other sq ft: PROJECT -- 1 ' DESCRIPTION h i -Ho deck axic� �e.�1-ace i �?I s "I i2A1 1 © k ma DD�r 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:-Lf:-41 ICU LAUL'I rr ' Signature: 1-Y, Date /� U7Z)4