BLD2022-0436_Application_4.5.2022_9.23.19_AM_2781606CITY OF EDMONDS MyBuildingPermit.com
Mechanical Application #1119194 - prejers ac
Applicant
First Name Last Name Company Name
jason burge Black Lion Heating and Air Conditioning
Number Street Apartment or Suite Number E-mail Address
11001 118th pl ne info@blacklionhvac.com
City State Zip Phone Number Extension
KIRKLAND WA 98033 4258143944
Contractor
Company Name
BLACK LION HEATING & A/C LLC
Number Street Apartment or Suite Number
11001 118th PL NE
City State Zip Phone Number Extension
KIRKLAND WA 98033 (425)814-3944
State License Number License Expiration Date UBI # E-mail Address
BLACKLH873QQ 11/18/2023 Rnimsggn info@blacklionhvac.com
Project Location
Number Street Floor Number Suite or Room Number
9002 217TH ST SW
City Zip Code County Parcel Number
EDMONDS 98026 00561000000100
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
Julian Paul & Roland Brittany Preijers
Number Street Apartment or Suite Number
9002 217TH ST SW
City State Zip
EDMONDS WA 98026
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: 4/5/2022 Submitted By: jason burge
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CITY OF EDMONDS M BuildingPermit.com
Mechanical Application #1119194 - prejers ac
Project Contact
Company Name: Black Lion Heating and Air
Conditioning
Name: jason burge Email: info@blacklionhvac.com
Address: 11001 118th pl ne Phone #: 4258143944
KIRKLAND WA 98033
Project Type Activity Type Scope of Work
Single Family Residential Repair or Replacement Mechanical
Project Name: prejers ac
Description of Work: ac 113 ana 024
Project Details
HVAC Systems
Air Conditioner 1
Associated Building Permit?
There is no other onsite work that requires a building
permit.
Work Location
Work Description/Location (example: 1st floor,
Master Bath, Garage) garage
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