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Application_1100425CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1100425 Applicant First Name Last Name Brian Lee Company Name Sundance Energy Services Inc Number Street 10228 Main Street Apartment or Suite Number E-mail Address brianl@sundanceenergy.com City State Zip Bothell WA 98011 Phone Number Extension 4254819660 Contractor Company Name Sundance Energy Services Inc Number Street 10228 Main Street Apartment or Suite Number City State Zip Bothell WA 98011 Phone Number Extension (425) 481-9660 State License Number License Expiration Date SUNDAES063J9 9/13/2023 UBI # E-mail Address BD15416:37 kevinl@sundanceenergy.com Project Location Number Street 19220 80TH PL W Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00572700000800 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 Nghi Van & Sally Quach Nguyen Number Street 19220 80TH PL W Apartment or Suite Number City State EDMONDS WA Zip 98026 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: 3/1/2022 Submitted By: Brian Lee Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1100425 Project Type Single Family Residential Project Details Appliances and Equipment Gas Piping Outlets - Mech Heaters Fireplace Insert - Gas Associated Building Permit? Activity Type Scope of Work Alteration Mechanical There is no other onsite work that requires a building permit. Work Location Work Description/Location (example: 1 st floor, Installing a new gas fireplace insert in family room Master Bath, Garage) Page 2 of 2