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BLD2022-0071+Application+1.20.2022_2.39.55_PM+2632671CITY OF EDMONDS MyBuilaingPermit.com Building Application #1079613 -Anthology of Edmonds Applicant First Name Last Name Company Name Michael Duqqan CA Senior Edmonds Property Owner, LLC Number Street Apartment or Suite Number E-mail Address 130 E. Randolph Street Suite 2100 mduggan(&_ca-ventures.com City State Zip Phone Number Extension Chicaqo IL 60601 3122482091 Contractor Company Name Contractor Unknown Number Street City State License Number Project Location State Zip License Expiration Date Number Street 21200 72ND AVE W City Zip Code EDMONDS 98026 Associated Building Permit Number BLD2021-0088 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Phone Number UBI # E-mail Address County Parcel Number 00580700000401 Tenant Name Anthology of Edmonds Floor Number 1 Apartment or Suite Number Extension Suite or Room Number None First Name Last Name or Company Name JAS GROUP LLC Number Street Apartment or Suite Number 154 LAKE WASHINGTON BLVD E City State Zip SEATTLE WA 98112 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: 1/20/2022 Submitted By: Michael Duggan Page 1 of 2 i o CITY OF EDMONDS MyBuildingPerrnit.cm „c Building Application #1079613 -Anthology of Edmonds Project Contact Company Name: CA Senior Edmonds Property Owner, LLC Name: Michael Duggan Email: mduggan@ca-ventures.com Address: 130 E. Randolph Street Suite Phone #: 3122482091 2100 Chicago IL 60601 Project Type Activity Type Mixed Use Partial Demolition Project Name: Anthology of Edmonds Description of Work: Demolition of the existing, on -site building to make way for the construction of a 6-story assisted living facility with at -level and below -grade parking. Project Details Demolition Scope More than interior nonbearing walls are being demolished. Page 2 of 2