ENG2024-0437+Application+9.6.2024_6.14.41_PM+4486157CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1543793 - Bothell Manor LLC Adult Home ROW
Applicant
First Name Last Name Company Name
Dan Bockretsion Bothell Manor LLC
Number Street Apartment or Suite Number E-mail Address
22422 46th Avenue SE bpmafhllc(c,gmail.com
City State Zip Phone Number Extension
Bothell 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
Number Street
1520 10TH PL N
City Zip Code
EDMONDS 98020
Associated Building Permit Number
BLD2024-0257
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name
Phone Number Extension
UBI # E-mail Address
County Parcel Number
27031300409000
Tenant Name
Last Name or Company Name
BOTHELL MANOR LLC
Floor Number
Suite or Room Number
Number Street Apartment or Suite Number
22422 97TH AVE 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: 9/6/2024 Submitted By: Dan Bockretsion
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CITY OF EDMONDS MyBuildinBPermit.com
Right -of -Way Application #1543793 - Bothell Manor LLC Adult Home ROW
Project Contact
Company Name: Bothell Manor LLC
Name: Dan Bockretsion Email: bpmafhllc@gmail.com
Address: 22422 46th Avenue SE Phone #: (425) 669-4882
Bothell WA 98020
Project Type
Single Family Residential
Activity Type Scope of Work
New Excavation and Utility Work
Project Name: Bothell Manor LLC Adult Home ROW
Description of Work: Construction of new Adult Family Home
Project Details
Project Information
Driveway Access
Utility Service Installation
Impervious Surface
Adding/Replacing 2,000 square feet or more of hard
surface
Clearing and Grading Information
This is redevelopment
Tree Removal
There are five or less significant trees to be removed
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