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BLD2022-0155+Application+2.6.2022_11.09.15_AM+2664319CITY OF EDMONDS MyBtaildingPermit.com Building Application #1088121 -Ross Addition Applicant First Name Last Name Company Name Robin Michel Michel Desiqn Number Street Apartment or Suite Number E-mail Address 3617 BELLS BEACH RD rwmichel1 (�D_me.com City State Zip Phone Number Extension Langley WA 98260 2069302445 Contractor Company Name Reqent Construction Inc Number Street Apartment or Suite Number 3617 BELLS BEACH RD City State Zip Phone Number Extension LANGLEY WA 98260 206-930-2445 State License Number License Expiration Date UBI # E-mail Address REGENC1891K5 5/25/2023 603055500 rwmichel1(a-)_me.com Project Location Number Street Floor Number Suite or Room Number 22624 105TH AVE W City Zip Code County Parcel Number EDMONDS 98020 00610400001500 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 Donald Q Ross Number Street Apartment or Suite Number 22624 105TH AVE W City State Zip EDMONDS WA 98020-5135 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: 2/6/2022 Submitted By: Robin Michel Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Building Application #1088121 -Ross Addition Project Contact Company Name: Michel Design Name: Robin Michel Email: rwmichel1@me.com Address: 3617 BELLS BEACH RD Phone #: 2069302445 Langley WA 98260 Project Type Single Family Residential Activity Type Scope of Work Structure Addition Residence Project Name: Ross Addition Description of Work: Add 1154 sq ft Two story addition Project Details Increasing Building Height? The height of the building is not increasing. Impervious Surface Adding/Replacing less than 2,000 square feet of hard surface Site Information There are no critical areas. Critical Areas Designation has been completed for the parcel Clearing and Grading Information Total cubic yards of cut and fill Mechanical Included? Mechanical work will occur during this project. Plumbing Included? Plumbing work will occur during this project. Work Location Work Description/Location (example: 1st floor, Master Bath, Garage) Valuation Fair Market Value of Construction Work 47 Addition located at back of existing home to the west. $164,000 Page 2 of 2