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Application_BLD2022-1715CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1243671 Applicant First Name Last Name Georgiy Abdulfaizov Company Name GEORGE GAS PIPING LLC Number Street 601 12th AVE NW Apartment or Suite Number E-mail Address E-4 georgegaspiping@gmail.com City State Zip Issaquah WA 98027 Phone Number Extension (425) 577-2452 Contractor Company Name GEORGE GAS PIPING LLC Number Street 601 12TH AVE NW E4 Apartment or Suite Number City State Zip ISSAQUAH WA 98027 Phone Number Extension (425) 577-2452 State License Number License Expiration Date GEORGGP849JQ 4/18/2024 UBI # E-mail Address F;n:3F;n7gnF; georgegaspiping@gmail.com Project Location Number Street 6908 161 ST PL SW Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00769600000500 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 Thomas Xcassandra Rae Atkinson Edwards Number Street 6908 161 ST PL SW Apartment or Suite Number City State EDMONDS WA Zip 98026 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: 12/16/2022 Submitted By: Georgiy Abdulfaizov Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1243671 Project Type Activity Type Scope of Work Single Family Residential Alteration Mechanical Project Details Appliances and Equipment Gas Piping Outlets - Mech Associated Building Permit? There is no other onsite work that requires a building permit. Work Location Work Description/Location (example: 1 st floor, New gas line installed for generator from gas meter. Master Bath, Garage) Page 2 of 2