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FIR2022-0012+Application+2.8.2022_3.23.15_PM+2669421CITY OF EDMONDS Fire Application #1089678 - Hoy Residence Applicant First Name Last Name BRENT BESANCON Number Street Apartment or Suite Numb 17146 Britt Rd City State Zip Mount Vernon WA 98273-6598 Contractor Company Name NW Custom Plumbinq LLC Number Street 3405 172nd st ne City State Zip Arlinqton WA 98223 State License Number License Expiration Date UBI # nwcuscp861 cs 2/20/2022 603373451 Project Location Number Street 8051 184TH ST SW MyBuildingPermit.com Company Name NW Custom Plumbinq er E-mail Address brent.nwcp(D_outlook.com Phone Number Extension (206)660-7442 Apartment or Suite Number 5-158 Phone Number Extension (206) 660-7442 E-mail Address brent.nwcp(c_outlook.com City Zip Code County Parcel Number EDMONDS 98026 27041800103800 Associated Building Permit Number Tenant Name BLD2019-1553 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Floor Number Suite or Room Number First Name Last Name or Company Name Gregory & Oka Midori Hoy Number Street Apartment or Suite Number 2630 77TH AVE SE A515 City State Zip MERCER ISLAND WA 98040 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: 2/8/2022 Submitted By: BRENT BESANCON Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Fire Application #1089678 - Hoy Residence Project Contact Company Name: NW Custom Plumbing Name: BRENT BESANCON Email: brent.nwcp@outlook.com Address: 17146 Britt Rd Phone #: (206)660-7442 Mount Vernon WA 98273-6598 Project Type Single Family Residential Activity Type Scope of Work New Fire Sprinkler Systems Project Name: Hoy Residence Description of Work: Installation of 13D Sprinkler system Project Details Fire System Type NFPA 13D Page 2 of 2