ENG2024-0036+Application+1.25.2024_1.02.16_PM+4020401CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1428144 - 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
State Zip
License Expiration Date UBI #
Number Street
654 4TH AVE S
City Zip Code County Parcel Number
EDMONDS 98020 00409600101100
Associated Building Permit Number Tenant Name
BLD2023-1219
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
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: 1/25/2024 Submitted By: Jay Fulton
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CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1428144 - Fulton Residence
Project Contact
Company Name:
Name: Jay Fulton Email: jay.fulton1@gmail.com
Address: 8630 112TH LN NE Phone #: (425) 827-4470
Kirkland WA 98033
Project Type Activity Type Scope of Work
Single Family Residential New Side Sewer Connection
Project Name: Fulton Residence
Description of Work: New SFR
Project Details
Structure Type
Single Family Dwelling
Project Information
Connection to City sewer service
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