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BLD2020-0544+Site_Plan+5.27.2020_6.06.40_PM
oV, E bM BUILDING PERMIT APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 �''� • I R`�� 425.771.0220 For handouts, submittal requirements go to: www, mondswa. ov. To apply far permits, schedule Inspections, or check application status go to. www.mybulldinaaermft,com 10B SITE IN FORMATION/LOCATION: (where the work is taking place) Job Site Address: 510 EdmoAdj Parcel: Lot /Unit/Suite If: Subdivision: BUSINESS OR PROPERTY OWNER: Name: 3 rt i O Mailing Address: S I4 e -Or. City/State/Zip: Tt; q p 10 Phone#: - } or 6?0-31a-i-4s Email: Wilme-rz"A& Q A00 . cotvq OWNER INSTALLATION: 'If yes, read and sign' �p j Will work be performed by the property owner? I/� Yes ❑ No I own, reside in, or will reside in the completed st`r-uure. 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: 11 Name of Applicant: t a- G:-Y7 a • r Mailing Address: City/State/Zip: Phone p: E-mail: GENERAL CONTRACTOR: (If different from applicant) General Contractor: Mailing Address: City/state/Zip: Phone /I: E-mail: STATE UBI P: CITY OF EDMONDS BUSINESS LICENSE 11: WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE: C;{I:CC USC--Only TYPE OF PERMIT (Piovide Accessory Structure/ Detached Garage Deia;ls on Page 2) Addition Demolition El Mechanical New Single Family/Duplex ❑ Plumbing Fire Sprinkler ❑ Remodel ElNew Commercial/Mixed Use Re -Roof Signs ❑ Tank ❑ Tenant Improvement Other (Z GQ 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 1he work indicated on this application. Valuation:cm RO POSE D N EW SQUrr OR r Basement sq it: Finished ❑ Unfinished 1st Floor, sq ft: 2nd Floor, sq it : Garage/Carport:, sq ft: Deck/Covered Porch/Patio: If of NEW Bedrooms: t# of NEW Bathrooms: PROJECT DESCRIPTION Co 4,41ce -fp 4f >acaM±r A. _I�,(�j)II611—tb 6LUI!cI _ IRCD n LCIUS 3 4 $ �¢ rI' ;A 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 applicatton to the City of Edmonds. !�}� 'nVn� Print Name: fY,� 1y �oi H 1' IG,r ciol1 Signature: ate t6 I/DJ DD'D49 09991 City Of Edmonds Building Department Work Address Owner Approved Date Building Official ermit Number IV$ to % ON APPROVED BY PLANNIN Jun 01 2020 RECEIVED May 28 2020 Rea u n t 15 ow ill 2 S-'%,crt Gernne-t.� J� tiM flank _ S -N_Vi OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE ENGINEERING DIVISION APPROVED AS NOTED All, WA%n-OU 06/10/2020 VV 0(cr I nXOil (,) 0 LA OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. U a -FENCE MUST BE ON PRIVATE PROPERTY rn -PROPERTY OWNER RESPONSIBLE FOR DETERMINING PROPERTY 01 LINES -FENCE SHALL NOT ENCLOSE OR PREVENT ACCESS TO ANY CITY MAINTAINED UTILITIES W2112020 Google Maps 510 Homeland Dr 510 Homeland Dr - Google Maps Map data ©2020, Map data ©2020 10 ft - W rap au o u rb, W 64 Isla-n tu S}� q -5 J4 n �O CX -M � a� o u (",d WN(to �ree5, 4b FRS ,Ir S- Tenff RECEIVED May 28 2020