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BLD2022-0009_Application_1.4.2022_1.16.45_PM_2602193CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1071695 - Blackstone Applicant First Name Last Name Company Name Patrick Dickinson Service Plumbing and Heating Inc Number Street Apartment or Suite Number E-mail Address 2100 196th St SW info@serviceph.net City State Zip Phone Number Extension Lynnwood WA 98036 4256402121 Contractor Company Name SERVICE PLUMBING & HEATING INC Number Street Apartment or Suite Number 2100 196th St SW City State Zip Phone Number Extension Lynnwood WA 98036 (425) 640-2121 State License Number License Expiration Date UBI # E-mail Address SERVIPH797NR 11/3/2023 FD99'1R671 info@serviceph.net Project Location Number Street Floor Number Suite or Room Number 523 MAPLE ST 101 City Zip Code County Parcel Number EDMONDS 98020 00642900000100 Associated Building Permit Number Tenant Name Blackstone-Altwegg Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Ellen Ann & Altwegg Christopher Blackstone Number Street Apartment or Suite Number 8203 38TH AVE NE City State Zip SEATTLE WA 98115 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: 1/4/2022 Submitted By: Patrick Dickinson Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1071695 - Blackstone Project Contact Company Name: Service Plumbing and Heating Inc Name: Patrick Dickinson Email: info@serviceph.net Address: 2100 196th St SW Phone #: 4256402121 Lynnwood WA 98036 Project Type Multifamily Residential Activity Type Repair or Replacement Scope of Work Plumbing Project Name: Blackstone Description of Work: Kitchen sink, dishwasher, hose bib, shower, water closet, lavatory, power room lavatory, water closet, water heater Project Details Scope of Work Like for like equipment in the same location Additional Project Information Total number of fixtures being added or altered Work Location Work Description/Location (example: 1st floor, Master Bath, Garage) Work to be performed by a licensed contractor Yes 10 Kitchen, Master Bath, Powder Room, Hot Water Page 2 of 2