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Application_1241560CITY OF EDMONDS MyBuildingPermitxom Mechanical Application #1241560 Applicant First Name Last Name Brad Hanshaw Company Name FROG HVAC LLC Number Street 3731 257th St NE Apartment or Suite Number E-mail Address brad@froghvac.com City State Zip Arlington WA 98223 Phone Number Extension (425) 359-7988 Contractor Company Name FROG HVAC LLC Number Street 3731 257th Street Northeast Apartment or Suite Number City State Zip Arlington WA 98223 Phone Number Extension 4253597988 State License Number License Expiration Date FROGHHL870P9 10/29/2023 UBI # E-mail Address FD:3V171 B� brad@froghvac.com Project Location Number Street 19637 80TH PL W Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00506400000900 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 John Wesley & Sara Lang Number Street 19637 80TH PL W Apartment or Suite Number City State EDMONDS WA Zip 98026-6404 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: 12/12/2022 Submitted By: Brad Hanshaw Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1241560 Project Type Single Family Residential Project Details Appliances and Equipment Gas Piping Outlets - Mech Work Location Activity Type Repair or Replacement Work Description/Location (example: 1 st floor, north side of home Master Bath, Garage) Scope of Work Mechanical Page 2 of 2