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Application_1007215CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1007215 Applicant First Name Last Name TOM KIMBALL Company Name KIMBALL MECHANICAL LLC Number Street 43901 SE 78TH ST Apartment or Suite Number E-mail Address KIMBALLMECHANICAL@YAHOO.COM City State Zip SNOQUALMIE WA 98065 Phone Number Extension 4258644745 Contractor Company Name KIMBALL MECHANICAL Number Street 43901 SE 78TH ST Apartment or Suite Number City State Zip SNOQUALMIE WA 98065 Phone Number Extension (425) 864-4745 State License Number License Expiration Date KI M BAM*946M 1 8/7/2022 UBI # E-mail Address BDg51 1 R31 KIMBALLMECHANICAL@YAHOO.COM Project Location Number Street 18300 ANDOVER ST Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 27041800106300 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 Shellane & Barry Adams Number Street 18300 ANDOVER ST Apartment or Suite Number City State EDMONDS WA Zip 98026-5429 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: 8/18/2021 Submitted By: TOM KIMBALL Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1007215 Project Type Activity Type Scope of Work Single Family Residential Alteration Mechanical Project Details Other BBQ, fire pit 2 Work Location Work Description/Location (example: 1st floor, to run gas for 1x bbq and 1x fire pit Master Bath, Garage) Page 2 of 2