ENG2022-0069+Application+2.22.2022_12.58.40_PM+2695506CITY OF EDMONDS
MyBuildingPermit.com
Utilities Application #1096819 - Edmonds Addition
Applicant
First Name
Last Name
Company Name
Michael
Smith
Chrysalis Homes, LLC
Number Street
Apartment or Suite Number
E-mail Address
PO Box 2415
1 keeper4me(�D_gmail.com
City State
Zip
Phone Number Extension
Kirkland WA
98083
4259485356
Contractor
Company Name
CHRYSALIS HOMES LLC
Number Street
Apartment or Suite Number
PO BOX 2415
City
State Zip
Phone Number Extension
KIRKLAND
WA 98083
4259485356
State License Number
License Expiration Date UBI #
E-mail Address
CHRYSHL838J5
6/26/2023 603600766
1 keeper4me(a-)_gmail.com
Project Location
Number Street
Floor Number Suite or Room Number
24025 79TH PL W
City
Zip Code County Parcel Number
EDMONDS
98026 00511600000800
Associated Building Permit Number
Tenant Name
BLD2021-1146
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name Last Name or Company Name
July Pan
Number Street Apartment or Suite Number
24025 79TH PL W
City State Zip
EDMONDS WA 98026
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: 2/22/2022 Submitted By: Michael Smith
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CITY OF EDMONDS MyBui[di ngPerrnit.com
Utilities Application #1096819 - Edmonds Addition
Project Contact
Company Name: Chrysalis Homes, LLC
Name: Michael Smith Email: lkeeper4me@gmail.com
Address: PO Box 2415 Phone #: 4259485356
Kirkland WA 98083
Project Type
Single Family Residential
Activity Type Scope of Work
Utility Modification Side Sewer Repair Only
Project Name: Edmonds Addition
Description of Work: Install approximately 20 feet of side sewer from the addition and connect to the existing
side sewer from the main house (still on private property).
Project Details
Project Information
Relocate
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