ENG2022-0255+Application+5.24.2022_12.34.20_PM+2890172-1; CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1147932 - 106384617
Applicant
First Name Last Name Company Name
Susan Sidick Puget Sound Enerqy- Corrosion Department
Number Street Apartment or Suite Number E-mail Address
1660 Park Lane susan.sidick(D_pse.com
City State Zip Phone Number Extension
Burlinqton WA 98233 (425) 457-6353
Contractor
Company Name
PUGET SOUND ENERGY INC
Number Street
Apartment or Suite Number
1660 Park Lane
City
State Zip
Phone Number Extension
Burlinqton
WA 98233
(206) 716-2641
State License Number
License Expiration Date
UBI # E-mail Address
PUGETSE032J 1
3/20/2024
179010055 susan.sidick(a_pse.com
Project Location
Number Street
Floor Number Suite or Room Number
633 WALNUT ST
City
Zip Code
County Parcel Number
EDMONDS
98020
00434209402900
Associated Building Permit Number
Tenant Name
106384617
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name Last Name or Company Name
Barbara Tollefson
Number Street Apartment or Suite Number
633 WALNUT ST
City State Zip
EDMONDS WA 98020-3421
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: 5/24/2022 Submitted By: Susan Sidick
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CITY OF EDMONDS MyBuildingPerrnit.com
Right -of -Way Application #1147932 - 106384617
Project Contact
Company Name: Puget Sound Energy- Corrosion
Department
Name: Susan Sidick Email: susan.sidick@pse.com
Address: 1660 Park Lane Phone #: (425) 457-6353
Burlington WA 98233
Project Type
Utility Purveyor
Activity Type
Utility Work
Scope of Work
Disturbance of Surface
Project Name: 106384617
Description of Work: Install gas service at approx 21' S to 5' N to 16' N c/I of Walnut St & 248' E c/I of 6th ave
s (1) 3X5 PAVING CUT (2) 3X3 PAVING CUTS ANTICIPATED
Project Details
Project Information
Job Number
106384617
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