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BLD2021-1325+Application+9.28.2021_9.53.24_AM+2432133RECEIVED BLD2021-1325 Sep 28 2021 de, CITY OF EDMONDS CITY OF EDMONDS MyBuildingPermit.com DEVELOPMENT SERVICES DEPARTMENT Plumbing Application #1003950 - Virginia Mason Edmonds Applicant First Name Last Name Company Name Tasia Keane Enviromech Number Street Apartment or Suite Number E-mail Address 430 SW 153rd St tasiak(D_enviromech.com City State Zip Phone Number Extension Burien WA 98166 2067621960 Contractor Company Name Enviromech Number Street Apartment or Suite Number 430 SW 153rd St City State Zip Phone Number Extension Burien WA 98166 2067621960 State License Number License Expiration Date UBI # E-mail Address ENVIR**951 PP 10/17/2021 601354268 leffr(a)_enviromech.com Project Location Number Street Floor Number Suite or Room Number 7315 212TH ST SW 2 207 City Zip Code County Parcel Number EDMONDS 98026 00566900500600 Associated Building Permit Number Tenant Name Virginia Mason Edmonds Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name * GAHC4 EDMONDS WA MOB LLC Number Street Apartment or Suite Number 18191 VON KARMAN AVE City State Zip IRVINE CA 92612 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: 9/28/2021 Submitted By: Tasia Keane Page 1 of 2 CITY OF EDMONDS Mysu;laingPerrnit.com Plumbing Application #1003950 - Virginia Mason Edmonds Project Contact Company Name: Name: Jeff Reindel Email: jeffr@enviromech.com Address: 430 SW 153rd St Phone #: 2067621960 Burien WA 98166 Project Type Activity Type Nonresidential Alteration Project Name: Virginia Mason Edmonds Description of Work: Rough -in and hookup (1) sink and faucet Project Details Type of Use Work does NOT have med gas, commercial kitchen, food svc, lab, medical, or dental use. Associated Building Permit? There is or will be a building permit associated with this work at the project location. Work Location Work Description/Location (example: 1 st floor, Suite 207 Master Bath, Garage) Scope of Work Plumbing Page 2 of 2