Application.pdff E
11.11 Al
City of
Edmonds
Permit Application Form
Form A,
Site Address; 15826 68 Ave West,, Suite #
Sno County Tax Account Parcel #: 00513100003704
Business/Tenant Name (if applicable):.
Mailing Address: „n 15826 68 Ave West
City: IMOIDStaie:_ WA 98026
Zi^
Phone: ( ) (425) 280-2526 FAX: ( )
E -Mail:
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Please provide a complete detailed written scope of work for the proposed
project.
Additions (additional square footage): Specify room use, floor level and square footage and
direction if applicable (i.e. 545 square foot master bedroom/bathroom addition on the second floor
with 140 square foot deck and 245 square foot kitchen addition on the main floor at south side of
house).
Remodels (interior renovations): Specify room uses and floor levels (i.e. combine bedrooms 1 and
2 on the main floor to create new master bedroom/bathroom; replace dining room sliding glass door
with new French doors, reconfigure kitchen with new island prep counter and install new gas fireplace
in the living room).
TEAR OFF AND REPLACE 21 SQUARES COMP. ROOFING. NO PLYWOOD REPLACEMENT.
L:ITEMPIBUILDING%W EBcheckllstslSFR.cOMM.APP.doc9/13/2006