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BLD2020-1346+Application+12.9.2020_1.06.23_PMCITY OF EDMONDS MyB�ildingPermit.com Sign Application #894882 - Edmonds Waterfront Center Sign Applicant First Name Last Name Company Name clayton moss Forma Number Street Apartment or Suite Number E-mail Address PO Box 1751 cmoss(�D_formaseattle.com City State Zip Phone Number Extension Edmonds WA 98020 2069205912 Contractor Company Name Contractor Unknown Number Street City State License Number Project Location State Zip License Expiration Date UBI # Number Street 220 RAILROAD AVE City Zip Code County Parcel Number EDMONDS 98020 27032300104200 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 EDMONDS CITY OF Number Street Apartment or Suite Number 250 5th Avenue S City State Zip EDMONDS WA 98020-3146 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: 12/9/2020 Submitted By: Clayton moss Page 1 of 2 i o CITY OF EDMONDS MyBuildingPerrnit.cm „c Sign Application #894882 - Edmonds Waterfront Center Sign Project Contact Company Name: Forma Name: clayton moss Email: cmoss@formaseattle.com Address: PO Box 1751 Phone #: 2069205912 Edmonds WA 98020 Project Type Nonresidential Activity Type Permanent Sign Project Name: Edmonds Waterfront Center Sign Description of Work: Projecting Sign, one quantity, non illuminated Project Details Sign 1 Type Building Mounted Additional Project Information Total number of signs installed 1 Total number of signs removed 0 Scope of Work Wall or Building Page 2 of 2