19911 89th Edited Permit Application11/20/2020
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f'110 BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements go to: www.edmondswo.gov.
To apply for permits, schedule inspections, or check application status
go to: www.mybuildingpermit.com
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 19911 89th PI. W
Parcel: 00506200000800
Lot /Unit/Suite #: Subdivision:
BUSINESS OR PROPERTY OWNER:
Name: White Maple LLC
Mailing Address: 546 Forsyth Ln
City/state/Zip: Edmonds, WA 98020
Phone #: 206.227.9501
Email: jeffvehrs@gmail.com
OWNER INSTALLATION: "If yes, read and sign*
Will work be performed by the property owner? aYes ❑No
I own, reside in, or will reside in the completed structure. This
installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange according to RCW
18.27.090.
Owner Signature: Jeff. Vehrs. member of LLC
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Jeff Vehrs
Mailing Address: 546 Forsyth Ln
City/State/Zip: Edmonds, WA 98020
Phone #: 206.227.9501
E-mail: jeffvehrs@gmail.com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #:
CITY OF EDMONDS BUSINESS LICENSE #:
WA STATE CONTRACTOR L & I #: (CCB) & EXPIRATION DATE:
Once ',Ise 0-1 y
TYPE OF
❑ Accessory Structure/
Addition
11
Detached Garage
Demolition
Mechanical
New Single Family/Duplex
❑ Plumbing
Fire Sprinkler
Remodel
❑ New Commercial/Mixed Use
Re -Roof
❑ Signs
❑ Tank
❑ Tenant Improvement
El Other
Remodel Permit fees are based on:
The value of the work performed- Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation: 2000 .t' F1,?i /i✓�`E�/r✓6_ 3T23
PROPOSED..
Basement sq ft: Finished ❑ Unfinished
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
# of NEW Bedrooms: # of NEW Bathrooms:
PROJECTDESCRIPTION
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I certify that the in ormation I have provided on this form/appl¢ation 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
Name: JeffNehrs
Print
Signature: Date 10 2!
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