BLD2020-0964+City_Application+9.12.2020_3.39.14_PMBUILDING PERMIT
APPLICATION
Development Services
- Building Division
121 5th Ave N / Edmonds, WA 98020
Inc i �yo 425.771.0220
For handouts, submittal requirements go to: www.edmondswo.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 15723 70th Ave W
Parcel:
Lot /Unit/Suite #: Subdivision:
U NS-i R C— UuSVh£
BUSINESS OR PROPERTY OWNER:
Name: Cameron Huebner
Mailing Address: 15723 70th Ave W
City/State/Zip: Edmonds, WA 98026
Phone #: 206-351-8716
Email: chuebners@gmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? zYes ❑ 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 exchang according to RCW
18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Cameron Huebner
Mailing Address: 15723 70th Ave W
City/State/Zip: Edmonds, WA 98026
Phone #: 206-351-87816
E-mail: chuebners@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:-
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE M
WA STATE CONTRACTOR L & I M (CCB) & EXPIRATION DATE:
Permit M:
.
Accessory Structure/
Detached Garage
Addition
Demolition
ZMechanical�� (�
❑ New Single Family/Duplex
W1 Plumbing
Fire Sprinkler
I V1 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: 50000
• .. •
Basement sq ft: Finished a Unfinished❑
1st Floor, sq ft:
2nd Floor, sgft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: 1 # of NEW Bathrooms: 1
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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: L' Aw+�RsJ UEl3 N��— or
Signature: Date 1 IZ iA