BLD2021-1379_Application_10.7.2021_10.30.54_AM_2450017CITY OF EDMONDS M BuildingPermit.com
Plumbing Application #1031284 - Hot Water Heater
Applicant
First Name Last Name Company Name
Catherine Selin
Number Street Apartment or Suite Number E-mail Address
21327 76th Ave. W. B5 ccselin@msn.com
City State Zip Phone Number Extension
Edmonds WA 98026 2069305875
Contractor
Company Name
Contractor Unknown
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
21327 76TH AVE W B5
City Zip Code County Parcel Number
EDMONDS 98026 00826500000500
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
Corneilia & Selin Catherine C Duryee
Number Street Apartment or Suite Number
21327 76TH AVE W B5
City State Zip
EDMONDS WA 98026
Certification Statement - The applicant states:
I 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. I
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: 10/7/2021 Submitted By: Catherine Selin
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CITY OF EDMONDS MyBuitdingPermit.com
Plumbing Application #1031284 - Hot Water Heater
Project Contact
Company Name:
Name: Catherine Selin Email: ccselin@msn.com
Address: 21327 76th Ave. W. B5 Phone #: 2069305875
Edmonds WA 98026
Project Type Activity Type
Single Family Condominium Unit Repair or Replacement
Project Name: Hot Water Heater
Description of Work: repair or replace hot water tank in garage
Project Details
Scope of Work
Like for like equipment in the same location
Associated Building Permit?
There is no other onsite work that requires a building
permit.
Additional Project Information
Total number of fixtures being added or altered
Work Location
Work Description/Location (example: 1st floor,
Master Bath, Garage)
1
Scope of Work
Plumbing
repair or replace 40 gal natural gas water heater
located in the garage.
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