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BLD2021-1236+Application+9.2.2021_1.38.53_PM+2333538CITY OF EDMONDS MyBuilaingPermit.com Building Application #999692 - Retaining Wall Demolition Applicant First Name Last Name Company Name Michael Samora Number Street Apartment or Suite Number E-mail Address 7330 172nd St SW mikesamora(D_hotmail.com City State Zip Phone Number Extension Edmonds WA 98026 4252207774 Contractor Company Name Contractor Unknown Number Street City State License Number Project Location State Zip License Expiration Date UBI # Number Street 7330 172ND ST SW City Zip Code County Parcel Number EDMONDS 98026 00513100013909 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Apartment or Suite Number Phone Number Extension E-mail Address Floor Number Suite or Room Number First Name Last Name or Company Name Amy M & Michael A Samora Number Street Apartment or Suite Number 7330 172ND 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: 9/2/2021 Submitted By: Michael Samora Page 1 of 2 CITY OF EDMONDS M BuildingPerrnit.cam Building Application #999692 - Retaining Wall Demolition Project Contact Company Name: Name: Michael Samora Email: mikesamora@hotmail.com Address: 7330 172nd St SW Phone #: 4252207774 Edmonds WA 98026 Project Type Single Family Residential Activity Type Scope of Work Demolition Accessory Building Project Name: Retaining Wall Demolition Description of Work: Remove existing upper and lower block retaining walls in City ROW adjacent to the north property line and regrade ROW to a 2H:1V inclination. Project Details Demolition Information Number of structures to be demolished. 1 Square feet to be demolished. 165 The year the structure was built. 2017 Page 2 of 2