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BLD2022-0393+Application+3.28.2022_4.29.05_PM+2766159CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1115209 - Transform Weight Loss Applicant First Name Last Name Company Name Kent Gregory tqb Number Street Apartment or Suite Number E-mail Address 21911 76th Ave W 210 kgregory(a_tgbarchitects.com City State Zip Phone Number Extension Edmonds WA 98020 4255994469 Contractor Company Name FERRIS/TURNEY GEN CONTRS INC Number Street Apartment or Suite Number 118 North 35th Street City State Zip Phone Number Extension Seattle WA 98103 2067935500 State License Number License Expiration Date UBI # E-mail Address FERRIGC037N1 5/28/2023 601809994 rodf(a_ferris-turney.com Project Location Number Street Floor Number Suite or Room Number 21911 76TH AVE W 1 103 City Zip Code County Parcel Number EDMONDS 98026 00545500200100 Associated Building Permit Number Tenant Name Transform Weiqht Loss Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name MASTGECH LLC Number Street Apartment or Suite Number 21911 76TH AVE W 100 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: 3/28/2022 Submitted By: Kent Gregory Page 1 of 2 CITY OF EDMONDS Mysu;laingPerrnit.com Mechanical Application #1115209 - Transform Weight Loss Project Contact Company Name: tgb Name: Kent Gregory Email: kgregory@tgbarchitects.com Address: 21911 76th Ave W 210 Phone #: 4255994469 Edmonds WA 98020 Project Type Nonresidential Activity Type Alteration Scope of Work Mechanical Project Name: Transform Weight Loss Description of Work: reconfigure duct work and diffusers in operating room in Ambulatory Surgery Suite Project Details Scope of Work Duct Work Only Associated Building Permit? There is or will be a building permit associated with this work at the project location. Work Location Work Description/Location (example: 1st floor, Master Bath, Garage) 1 st floor. Reconfiguration of duct work and diffusers in Operating Room in Ambulatory Surgery Suite Page 2 of 2