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BLD2023-1223+Application+9.29.2023_4.01.21_PM+3813661CITY OF EDMONDS MyBuildingPermit.com Building Application #1382676 - Fulton Residence Applicant First Name Last Name Company Name Jay Fulton Number Street Apartment or Suite Number E-mail Address 8630 112TH LN NE jay.fulton1l'gD_gmail.com City State Zip Phone Number Extension Kirkland WA 98033 (425) 827-4470 Contractor Company Name Contractor Unknown Number Street City State License Number Project Location Number Street 654 4TH AVE S City EDMONDS Associated Building Permit Number State Zip License Expiration Date UBI # Zip Code County Parcel Number 98020 00409600101100 Tenant Name Vacant 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 1 None First Name Last Name or Company Name Jay A & Merri Keefer Fulton Number Street Apartment or Suite Number 8630 112TH LANE NE City State Zip KIRKLAND WA 98033 Certification Statement - The applicant states: 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. 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: 9/29/2023 Submitted By: Jay Fulton Page 1 of 2 i CITY OF EDMONDS MyBuildinBPermit.com Building Application #1382676 - Fulton Residence Project Contact Company Name: Name: Address: Project Type Nonresidential Jay Fulton Email: jay.fulton1@gmail.com 8630 112TH LN NE Phone #: (425) 827-4470 Kirkland WA 98033 Activity Type Demolition Project Name: Fulton Residence Description of Work: Demolition of existing garage. Project Details Demolition Information Number of structures to be demolished. 1 Square feet to be demolished. 528 The year the structure was built. 1958 Scope of Work Accessory Building Page 2 of 2