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Application_2021-1389CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1031810 Applicant First Name Last Name Jeff Stollwerck Company Name Stollwerck Plumbing & Sewer LLC Number Street 611 5th Street Apartment or Suite Number E-mail Address B jd@stollwerckplumbing.com City State Zip Mukilteo WA 98275 Phone Number Extension 4253743909 Contractor Company Name Stollwerck Plumbing LLC Number Street 3906 68th Dr NE Apartment or Suite Number City State Zip Marysville WA 98270 Phone Number Extension (206) 302-8382 State License Number License Expiration Date STOLLPL880MC 8/5/2022 UBI # E-mail Address Fn.'19n 31 D4 jd@stollwerckplumbing.com Project Location Number Street 8532 FREDERICK PL Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00594400005801 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 Michael & Nancy Katims Number Street 8532 FREDERICK PL Apartment or Suite Number City State EDMONDS WA Zip 98026 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: 10/8/2021 Submitted By: Jeff Stollwerck Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1031810 Project Type Single Family Residential Project Details Activity Type Repair or Replacement Fixtures Shower, Tub or Combo 1 Toilet 1 Work Location Work Description/Location (example: 1st floor, Main Bath Master Bath, Garage) Scope of Work Plumbing Page 2 of 2