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FIR2023-0092+Application+9.21.2023_11.48.00_AM+3796969CITY OF EDMONDS nnyst,ilaingPermit.com Special Use or Event Application #1379065 - Barn Applicant First Name Last Name Company Name Ryan Hoff Windermere Real Estate Number Street Apartment or Suite Number E-mail Address 210 5th Ave S 102 rhoff(�D_windermere.com City State Zip Phone Number Extension Edmonds WA 98020 (206) 919-2594 Contractor Company Name Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 228 5TH AVE S City Zip Code County Parcel Number EDMONDS 98020 27032300408000 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name JIM BOB INVESTMENTS LLC Number Street Apartment or Suite Number 234 5TH AVE S City State Zip EDMONDS WA 98020 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: 9/21/2023 Submitted By: Ryan Hoff Page 1 of 2 i CITY OF EDMONDS MyBoi[di ngPerrnit.com Special Use or Event Application #1379065 - Barn Project Contact Company Name: Windermere Real Estate Name: Ryan Hoff Email: rhoff@windermere.com Address: 210 5th Ave S 102 Phone #: (206) 919-2594 Edmonds WA 98020 Project Type Activity Type Scope of Work Any Project Type Special Use Outdoor Seating Project Name: Barn Description of Work: Beers in Barn Project Details Event Location Private Property Event Date Begin Date 10/2/2023 End Date 10/2/2023 Page 2 of 2