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Application_977409CITY OF EDMONDS M BuildingPermit.com Plumbing Application #977409 Applicant First Name Last Name Company Name Douglas Romer None Number Street Apartment or Suite Number E-mail Address 19918 88th Ave W Dougflomer@yahoo.com City State Zip Phone Number Extension Edmonds WA 98026 4259312357 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 19918 88TH AVE W City Zip Code County Parcel Number EDMONDS 98026 00506200000300 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 Douglas Romer Number Street Apartment or Suite Number 19918 88TH AVE W City State Zip EDMONDS WA 98026-6309 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent, including an appropriately licensed contractor. I have furnished true and correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above may result in revocation of the permit. Date Submitted: 6/14/2021 Submitted By: Douglas Romer Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #977409 Project Type Single Family Residential Project Details Fixtures Water Heater - Gas Mechanical Work Location Activity Type Repair or Replacement Scope of Work Plumbing Work Description/Location (example: 1 st floor, How water tank is located in day light Basement Master Bath, Garage) Page 2 of 2