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Application_BLD2022-1280CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1206900 Applicant First Name Serghei Last Name Sturza Company Name PRIME SYSTEMS LLC Number Street 8634 NE 132nd PI Apartment or Suite Number E-mail Address primesystems19@gmail.com City State Kirkland WA Zip 98034 Phone Number Extension (425) 326-7846 Contractor Company Name PRIME SYSTEMS LLC Number Street 8634 NE 132nd PL Apartment or Suite Number City KIRKLAND State Zip WA 98034 Phone Number Extension (425)326-7846 State License Number PRIMESL813LM License Expiration Date 6/14/2023 UBI # E-mail Address RD44RPni4 primesystems19@gmail.com Project Location Number Street 17001 73RD PL W Floor Number Suite or Room Number City EDMONDS Zip Code 98026 County Parcel Number 00741500001800 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Dan D Last Name or Company Name Tintinger Number Street 17001 73RD PL W Apartment or Suite Number City EDMONDS State WA Zip 98026-5114 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: 9/26/2022 Submitted By: Serghei Sturza Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1206900 Project Type Activity Type Scope of Work Single Family Residential Repair or Replacement Mechanical Project Details HVAC Systems Furnace Work Location Work Description/Location (example: 1st floor, Garage Master Bath, Garage) Page 2 of 2