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Application_2022-0112CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1083234 Applicant First Name Last Name Company Name Theresa Kennebrew Number Street Apartment or Suite Number E-mail Address 18107 69th PI W theresakennebrew@gmail.com City State Zip Phone Number Extension EDMONDS WA 98026 2066504979 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 18107 69TH PL W City Zip Code County Parcel Number EDMONDS 98026 00906400001200 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 Theresa A Kennebrew Number Street Apartment or Suite Number 18107 69TH PL W City State Zip EDMONDS WA 98026-5611 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: 1/27/2022 Submitted By: Theresa Kennebrew Page 1 of 2 i CITY OF EDMONDS MyBuitdingPermit.com Plumbing Application #1083234 Project Type Single Family Residential Project Details Activity Type Repair or Replacement Scope of Work Like for like equipment in the same location Piping Piping - Water Service Water Supply Piping Associated Building Permit? There is no other onsite work that requires a building permit. Work Location Scope of Work Plumbing Work Description/Location (example: 1st floor, 18107 69th PL W, Edmonds WA 98026 Master Bath, Garage) Page 2 of 2