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BLD2023-0533+Application+5.1.2023_12.12.09_PM+3315541CITY OF EDMONDS MyBuildingPermit.com Building Application #1254243 - Rodriguez/Jacobs Addition Applicant First Name Last Name Company Name Cassandra Rodriquez (Jacobs) Number Street Apartment or Suite Number E-mail Address 7709 200th St SW cassrod4(o)_yahoo.com City State Zip Phone Number Extension Edmonds WA 98026 (425) 218-9073 Contractor Company Name Owner Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 7709 200TH ST SW City Zip Code County Parcel Number EDMONDS 98026 27041900103700 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 Cassandra Rodriquez (Jacobs) Number Street Apartment or Suite Number 7709 200TH ST SW City State Zip EDMONDS WA 98026 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: 5/1/2023 Submitted By: Cassandra Rodriguez (Jacobs) Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Building Application #1254243 - Rodriguez/Jacobs Addition Project Contact Company Name: Name: Cassandra Rodriguez (Jacobs) Email: cassrod4@yahoo.com Address: 7709 200th St SW Phone #: (425) 218-9073 Edmonds WA 98026 Project Type Activity Type Scope of Work Single Family Residential Structure Addition Residence Project Name: Rodriguez/Jacobs Addition Description of Work: Bedroom and bathroom add -on to residential property. 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. Clearing and Grading Information Total cubic yards of cut and fill 50 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, Bedroom and bathroom addition. Master Bath, Garage) Valuation Fair Market Value of Construction Work $80,000 Page 2 of 2