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BLD2024-0091+Application+1.19.2024_3.11.47_PM+4010245CITY OF EDMONDS MyBuitdingPermit.com Building Application #1426252 - Gronvold Residence - Fire Damage Repair Applicant First Name Last Name Company Name Chris Bacus Pacific Enqineerinq Technoloqies Number Street Apartment or Suite Number E-mail Address 2150 N. 107th St. 320 cbacus(a_)_pacengtech.com City State Zip Phone Number Extension Seattle WA 98133 (206) 281-7500 Contractor Company Name BELFOR USA GROUP INC Number Street Apartment or Suite Number 4320 S 131 st PI 100 City State Zip Phone Number Extension Seattle WA 98168 (206) 549-4604 State License Number License Expiration Date UBI # E-mail Address BELFOUG99OBJ 12/20/2024 602089710 todd.durgan(aD_us.belfor.com Project Location Number Street Floor Number Suite or Room Number 8101 240TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00451900201905 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 Kari Gronvold Number Street Apartment or Suite Number 8101 240TH ST SW City State Zip EDMONDS WA 98026-9119 Certification Statement - The applicant states: 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. 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: 1/19/2024 Submitted By: Chris Bacus Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Building Application #1426252 - Gronvold Residence - Fire Damage Repair Project Contact Company Name: Pacific Engineering Technologies Name: Chris Bacus Email: cbacus@pacengtech.com Address: 2150 N. 107th St. 320 Phone #: (206) 281-7500 Seattle WA 98133 Project Type Activity Type Scope of Work Single Family Residential Remodel Residence Project Name: Gronvold Residence - Fire Damage Repair Description of Work: Fire Damage Repair to an existing single family residence Project Details Mechanical Included? No mechanical work will occur during this project. Plumbing Included? No plumbing work will occur during this project. Work Location Work Description/Location (example: 1 st floor, Whole House Master Bath, Garage) Valuation Fair Market Value of Remodeling Work $251,000 Exterior Changes? The work does not involve changes to the exterior Contact Information Owner Email Address Owner does not have email Page 2 of 2