BLD2022-0944_Application_7.18.2022_5.30.46_AM_2994158CITY OF EDMONDS MyBuildingPermit.com
Mechanical Application #1174264 - daniel mech
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 (425) 814-3944
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
22422 97TH AVE W
City Zip Code County Parcel Number
EDMONDS 98020 00559000100300
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
Daniel E Bockretsion
Number Street Apartment or Suite Number
18009 29TH AVE SE
City State Zip
BOTHELL WA 98012
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: 7/18/2022 Submitted By: jason burge
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CITY OF EDMONDS M BuildingPermit.com
Mechanical Application #1174264 - daniel mech
Project Contact
Company Name: Black Lion Heating and Air
Conditioning
Name: jason burge Email: info@blacklionhvac.com
Address: 11001 118th pl ne Phone #: (425) 814-3944
KIRKLAND WA 98033
Project Type Activity Type Scope of Work
Single Family Residential Repair or Replacement Mechanical
Project Name: daniel mech
Description of Work: ductless hp
Project Details
HVAC Systems
Heat Pump 1
Work Location
Work Description/Location (example: 1st floor,
Master Bath, Garage) garage
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