BLD2021-1582+Application+11.19.2021_4.14.23_PM+2531093CITY OF EDMONDS nnyst,ilaingPermit.com
Building Application #1053094 - Davis Retrofit
Applicant
First Name Last Name Company Name
Matt Robinson EVERGREEN SEISMIC LLC
Number Street Apartment or Suite Number E-mail Address
21304 82nd PI SE info(.@_evergreenseismic.com
City State Zip Phone Number Extension
Snohomish WA 98290 (206)715-3957
Contractor
Company Name
EVERGREEN SEISMIC LLC
Number Street Apartment or Suite Number
21304 82nd PI SE
City State Zip Phone Number Extension
SNOHOMISH WA 98290 (206)715-3957
State License Number License Expiration Date UBI # E-mail Address
EVERGSL823JF 4/9/2022 604237947 info(a)_evergreenseismic.com
Project Location
Number Street Floor Number Suite or Room Number
22519 95TH PL W
City Zip Code County Parcel Number
EDMONDS 98020 00544300007100
Associated Building Permit Number Tenant Name
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name Last Name or Company Name
William L\mary Davis
Number Street Apartment or Suite Number
22519 95TH PL W
City State Zip
EDMONDS WA 98020
Certification Statement - The applicant states:
I 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. I
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: 11/19/2021 Submitted By: Matt Robinson
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CITY OF EDMONDS MyBuildingPermit.com
Building Application #1053094 - Davis Retrofit
Project Contact
Company Name: EVERGREEN SEISMIC LLC
Name: Matt Robinson Email: info@evergreenseismic.com
Address: 21304 82nd PI SE Phone #: (206)715-3957
Snohomish WA 98290
Project Type
Single Family Residential
Activity Type Scope of Work
Remodel Residence
Project Name: Davis Retrofit
Description of Work: Voluntary seismic retrofit upgrade to crawlspace of SFR, per "PROJECT IMPACT"
plan set (SEHR). No earth disturbance.
Project Details
Mechanical Included?
No mechanical work will occur during this project.
Plumbing Included?
No plumbing work will occur during this project.
Work Location
Work Description/Location (example: 1st floor,
Master Bath, Garage)
Valuation
Fair Market Value of Remodeling Work
Exterior Changes?
The work does not involve changes to the exterior
Interior of crawlspace.
$3,500
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