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BLD2022-0606+Application+5.9.2022_3.23.54_PM+2857267CITY OF EDMONDS Sign Application #1139549 - Fire Sign Applicant First Name Last Name Shubert Ho Number Street Apartment or Suite Number 526 Main City State Zip edmonds WA 98020 Contractor Company Name CUSTOM WOODWORK Number Street 1312 3RD ST City KIRKLAND State License Number CUSTOW*178RR Project Location Number Street 526 MAIN ST City EDMONDS Associated Building Permit Number State Zip WA 980335535 License Expiration Date UBI # 10/19/2022 600411284 Zip Code County Parcel Number 98020 00434212000900 Tenant Name Fire & The Feast Additional Information (i.e. equipment location or special instructions). Work Location Property Owner MyBuildingPermit.com Company Name E-mail Address shubert(D_feedmehrg.com Phone Number Extension 2065885148 Apartment or Suite Number Phone Number Extension 2065885148 E-mail Address shubertho@gmail.com Floor Number Suite or Room Number 1 First Name Last Name or Company Name * ELSIA LLC Number Street Apartment or Suite Number 18411 AURORA AVE N City State Zip SHORELINE WA 98133 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: 5/9/2022 Submitted By: Shubert Ho Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Sign Application #1139549 - Fire Sign Project Contact Company Name: Name: Shubert Ho Email: shubert@feedmehrg.com Address: 526 Main Phone #: 2065885148 edmonds WA 98020 Project Type Activity Type Nonresidential Permanent Sign Project Name: Fire Sign Description of Work: New Blade Sign at Fire & the Feast Project Details Sign 1 Type Building Mounted Additional Project Information Total number of signs installed 1 Total number of signs removed 0 Scope of Work Wall or Building Page 2 of 2