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Application_1271582CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1271582 Applicant First Name Last Name Kathleen Kappen Company Name Ballard Natural Gas Service Number Street 2027 196th St SW Apartment or Suite Number E-mail Address A101 permits@ballardnaturalgas.com City State Zip Lynnwood WA 98036 Phone Number Extension (206) 784-8101 Contractor Company Name BALLARD NATURAL GAS SRVC INC Number Street 2027 196th St SW Apartment or Suite Number A101 City State Zip Lynnwood WA 98036 Phone Number Extension (206) 784-8101 State License Number License Expiration Date BALLANG062QD 12/6/2023 UBI # E-mail Address BD15nR.147 permits@ballardnaturalgas.com Project Location Number Street 17627 69TH PL W Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00513100015412 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 H & Marla A Hughes Number Street 17627 69TH PL W 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: 2/21/2023 Submitted By: Kathleen Kappen Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1271582 Project Type Activity Type Scope of Work Single Family Residential Repair or Replacement Mechanical Project Details Heaters Heater - Gas 1 Associated Building Permit? There is no other onsite work that requires a building permit. Work Location Work Description/Location (example: 1 st floor, 1 st floor Master Bath, Garage) Page 2 of 2