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BLD2021-1469+Application+10.26.2021_1.46.16_PM+2484070CITY OF EDMONDS M BtaildingPermit.com Clearing and Grading Application #1040029 -19508 88th Ave W - Grading permit Applicant First Name Last Name Company Name Kayla Nichols Select Homes, Inc. Number Street Apartment or Suite Number E-mail Address 8304 212th St SW kayla.clark(D_outlook.com City State Zip Phone Number Extension Edmonds WA 98026 4257426044 Contractor Company Name Select homes inc Number Street Apartment or Suite Number 8304 212th St SW City State Zip Phone Number Extension Edmonds WA 98026 (425) 742-6044 State License Number License Expiration Date UBI # E-mail Address SELECH1110KN 1/2/2023 601148280 kayla.clark(c_outlook.com Project Location Number Street Floor Number Suite or Room Number 19508 88TH AVE W City Zip Code County Parcel Number EDMONDS 98026 27041800303400 Associated Building Permit Number Tenant Name vacant Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name SELECT HOMES INC Number Street Apartment or Suite Number 8304 212TH ST SW 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: 10/26/2021 Submitted By: Kayla Nichols Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com ,.,I,,.. Clearing and Grading Application #1040029 -19508 88th Ave W - Grading permit Project Contact Company Name: Select Homes, Inc. Name: Kayla Nichols Email: kayla.clark@outlook.com Address: 8304 212th St SW Phone #: 4257426044 Edmonds WA 98026 Project Type Commercial Activity Type New Scope of Work Clearing and Grading Project Name: 19508 88th Ave W - Grading permit Description of Work: grading permit - 80 yards brought in Project Details Development Type Stand-alone Clearing and Grading Project Information This is a new development Clearing and Grading Information Total cubic yards of cut and fill 80 Page 2 of 2