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20161117120254.pdfi7 Lll�/7 r DEVELOPMENT SERVICES RESIDENTIAL BUILDING PERMIT APPLICATION . st ifly 121 5t�Avenue N, Edmonds, WA 98020 City of Edmonds Phone 425.771.0220 f Fax 425.771.0221 PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS OJ C 1' ADDRESS (Street, Suite #, it State, Zip): Parcel #: I�ItY _ na � ! J Subdivision/Lot #: Project Valuation: $ APPL C NT: Phone: Fax, � o p Add es©Str et,�ity, state, Z vO ' ►t e.l �I �' VsgZ Q E-Mtress: � ®hd M0-k •C PROPERTY OWNE • Phone: Fax; 1),VL` TS �-��� Address (Street, City, State, Zip): E-Mail Address: ,941 —0C we p i C_ t<d tMBv1�S LENDING A E CY: Phone: Fax; Address (Street, City, State, Zip): E-Mail Address, CONTRACTOR:* Phone: Fax. A ress ( treet, City, State, Zip): E-Mail Address: + , D" cnv ' oGcl 80 4ItceLCLUM"- ", e- M ��CdKq W ttc License #/Exp. Date: *Contractor must have a valid City of'Edmonds business license prior to Le-G / C P S t 7 (7 doing work in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date: DETAIL THE SCOPE I yc ,t PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement... .. e� sa . ft. Select Basement T e: Finished [_J Unfinished I" Floor:._... _ ...._...... __... —sq. ft. Garage/Carport: 2"' Floor: �.m .�_... s . ft, Deck/Cvrd Porch/Patio: _... . Bedrooms # Full-3/4 Bath # Half -Bath # Other: ee .....n,,._.. _ -Sq. ft. Fire S rinklers: Yes No Retainin Wall: Yes No Grading: Cut cu. yds. Fill cu.yds. Cut/Fill in Critical Area: Yes No I declare under penalty of perjury laws 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 owner to submit a permit application to the City of Edmonds. , Print Name m <-�. �",_ql "—.....,..�. Owner Agent/Other ❑ (specify): „ t _ l Signature: - _n.... ......... Date (....��5.... �_,.,... u M A L:\Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form A2014.docx Updated: 1/17/2014 ..