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Application_2021-1273CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1019285 Applicant First Name Last Name Company Name Dan Radley Number Street Apartment or Suite Number E-mail Address 7026 210th street SW dkktr4@msn.com City State Zip Phone Number Extension Edmonds WA 98020 2062405066 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 7026 210TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00566900600104 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 Daniel & Kerry Radley Number Street Apartment or Suite Number 7026 210TH ST SW City State Zip EDMONDS WA 98026-7218 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: 9/14/2021 Submitted By: Dan Radley Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1019285 Project Type Single Family Residential Project Details Piping Water Supply Piping Work Location Activity Type Repair or Replacement Scope of Work Plumbing Work Description/Location (example: 1 st floor, repair water service line between meter and house Master Bath, Garage) Page 2 of 2