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FIR2021-0154+Application+12.28.2021_11.14.58_AM+2593864CITY OF EDMONDS MyBuildingPermit.com Fire Application #1069498 - Edmonds 20114 Applicant First Name Last Name Company Name maureen robertson Lakeside Plumbinq & Heatinq, Inc. Number Street Apartment or Suite Number E-mail Address 17104 33rd Ave. N.E. PO Box 65266 lakesideph(.@_comcast.net City State Zip Phone Number Extension Seattle WA 98155 206-363-4513 Contractor Company Name LAKESIDE PLUMBING & HTG INC Number Street Apartment or Suite Number 17104 33rd Ave. N.E. PO Box 65266 City State Zip Phone Number Extension Seattle WA 98155 206-363-4513 State License Number License Expiration Date UBI # E-mail Address LAKESPH001 OA 9/1 /2023 602062777 lakesideph(D_comcast.net Project Location Number Street Floor Number Suite or Room Number 20114 83RD AVE W City Zip Code County Parcel Number EDMONDS 98026 00431200000402 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 HomeCraft Number Street Apartment or Suite Number 20114 83RD AVE W 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: 12/28/2021 Submitted By: maureen robertson Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Fire Application #1069498 - Edmonds 20114 Project Contact Company Name: Lakeside Plumbing & Heating, Inc. Name: maureen robertson Email: lakesideph@comcast.net Address: 17104 33rd Ave. N.E. PO Box Phone #: 206-363-4513 65266 Seattle WA 98155 Project Type Single Family Residential Activity Type Scope of Work New Fire Sprinkler Systems Project Name: Edmonds 20114 Description of Work: Fire sprinkler system installation, rough and trim. Project Details Fire System Type NFPA 13D Page 2 of 2