BLD2025-0068_Letter_1.16.2025_9.21.07_AM_4714575Point Edwards for Remodel
Applicant
Name: SCoS W._6}} ,\ or T Owner ClosingDate:
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Current address: ne Phone: ,1U(o
City: ��oS State: WA
Contact Information: <+,;r„^fit,✓`; (-o'T Hour available.: (,w Ani,)
Alternative Phone #:
Description of Work to . • Done
Please list all work to be completed and drawing of work to be completed.
Approximate value for insurance reasons:
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Required Contractor Information
Name: \ ' cLZ
Current address:
City: J , , F State: WA ZIP Code: $ J
Phone: Xa — 33 3 � Hours available:
License #: ��L q v e 9 3) Cx Y—
Insurance Bond: / a a J•�
Insurance Provider:
Performance History: C..O.f Q," s 1,\c 'izg.
Notification Obligation — Adjoining units (Above. Below, One or Both Sides)
Name: Unit:
Name:
Unit:
Name:
Unit:
I authorize the verification of the information provided on this form. I agree to complete the Installaticn of Hard Surfa_e Flooring in strict
compliance with the Point Edwards HOA Board approved plan. I have a copy of this application.
Signature of applicant:
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Date: / `�2 i 3
Signature of applicant:
Date:
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