BLD2021-1180+Application+8.25.2021_11.21.21_AM+2375395CITY OF EDMONDS
Plumbing Application #1010599 - Lifestance
Applicant
First Name Last Name
Amy Diekevers
Number Street Apartment or Suite Number
75 60th St SW
City State Zip
Wyoming MI 49548
Contractor
Company Name
Contractor Unknown
Number Street
City
State License Number
Project Location
Number Street
21727 76TH AVE W
City
EDMONDS
Associated Building Permit Number
State Zip
License Expiration Date UBI #
Zip Code County Parcel Number
98026 00580700002701
Tenant Name
Lifestance
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
MyBoildingPermit.com
Company Name
Precision Permits
E-mail Address
amyd(D_precision permits. com
Phone Number Extension
6164939334
Apartment or Suite Number
Phone Number Extension
E-mail Address
Floor Number Suite or Room Number
1 C
First Name Last Name or Company Name
HR ACQUISITION I CORPORATION
Number Street Apartment or Suite Number
3310 W END AVE 700
City State Zip
NASHVILLE TN 37203
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: 8/25/2021 Submitted By: Amy Diekevers
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CITY OF EDMONDS MyBuildingPermit.com
Plumbing Application #1010599 - Lifestance
Project Contact
Company Name: Precision Permits
Name: Amy Diekevers
Address: 75 60th St SW
Wyoming MI 49548
Project Type
Nonresidential
Email: amyd@precisionpermits.com
Phone #: 6164939334
Activity Type
Alteration
Project Name: Lifestance
Description of Work: tenant improvement
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: 1st floor,
Master Bath, Garage)
Scope of Work
Plumbing
tenant improvement/1 st floor
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