BLD2024-0302+CITYAPP+3.6.2024_7.32.32_AM+4106292BUILDING PERMIT
APPLICATION
Development Services
Building Division
127 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswa aov.
To apply for permits, schedule inspections, or check application status
go to: www.mvbuildinaaermit.com
IS SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 7207 212th ST SW
Parcel: 00566900500301
Lot/Unit/Suite#: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: � fI�'1ln^/-` �Cj(`�'�p/ Nnj u—C
Mailing Address: 1412o('I�', 4C) \ (,
City/State/Zip:Q
Phone #:
Email:
OWNER INSTALLATION: 'If yes, read and sign*
Will work be performed by the property owner? ❑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
18.27.090.
Owner Signature:
APPLICANT/ CONTACT INFORMATION:
Name of Applicant: Shari Rust
Mailing Address: 4549 125th Ave SE
City/State/Zip: Bellevue, WA 98006
Phone #: 206-406-3437
E-mail: shari@newimagecreative.com
GENERAL CONTRACTOR: (If different from applicant)
General contractor: New Image Creative Sign Inc.
MailingAddress4549 125th Ave SE
City/State/Zip: Bellevue, WA 98006
Phone #: 206-406-3437
E-mail: shari@newimagecreative.com
STATE UBI #: 602-339-833
CITY OF EDMONDS BUSINESS LICENSE #: 602-339-833
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
NEWIMIC961 B9 03/22/2026
Office Use Only
TYPE OF
Accessory Structure/
Detached Garage
Details
Addition
El
10 Demolition
0 Mechanical
New Single Family/Duplex
Plumbing
Fire Sprinkler
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: 10,300.00
Basement sq it: Finished) I Unfinished
1st Floor, sq ft: u
2nd Floor, sq h:
Garage/Carport:, sq it:
Deck/Covered Porch/Patio:
#of NEW Bedrooms: #of NEW Bathrooms:
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 ow o sub it a permit application to the City of
Edmonds.
Print Na : Sha4vi st
Signature;Date 03/01/2024