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ENG2024-0430+Application+8.29.2024_11.32.43_AM+4470635CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1540006 - Bothell Manor LLC Adult Home Water Applicant First Name Last Name Company Name Dan Bockretsion Point of Vision Number Street Apartment or Suite Number E-mail Address 22422 97TH AVENUE W bpmafhllc(c,gmail.com City State Zip Phone Number Extension Edmonds WA 98020 (425) 669-4882 Contractor Company Name Contractor Unknown Number Street Apartment or Suite Number City State License Number Project Location State Zip License Expiration Date UBI # Number Street 1520 10TH PL N City Zip Code County Parcel Number EDMONDS 98020 27031300409000 Associated Building Permit Number Tenant Name BLD2024-0257 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Phone Number Extension E-mail Address Floor Number Suite or Room Number First Name Last Name or Company Name Dan BOTHELL MANOR LLC Number Street Apartment or Suite Number 22422 97TH AVE W 97TH AVENUE W City State Zip EDMONDS WA 98020 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: 8/29/2024 Submitted By: Dan Bockretsion Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1540006 - Bothell Manor LLC Adult Home Water Project Contact Company Name: Point of Vision Name: Dan Bockretsion Email: bpmafhllc@gmail.com Address: 22422 97TH AVENUE W Phone #: (425) 669-4882 Edmonds WA 98020 Project Type Single Family Residential Activity Type Scope of Work Water Meter Domestic - Fire Combo Project Name: Bothell Manor LLC Adult Home Water Description of Work: New Adult Family Home Project Details Water Meter Type Domestic and Fire Combo Water Meter Size Water meter 1.0 Page 2 of 2