BLD2022-0641+Application+5.17.2022_8.52.47_AM+2519186CITY OF EDMONDS
MyBuildingPermit.com
Building Application #1042979 - Edmonds Med
Applicant
First Name Last Name
Company Name
Mohamadreza - Babak Mojarad
QuaITM General Construction
Number Street Apartment or Suite Number
E-mail Address
6917 120TH AVE NE
bob@qualtm.com
City State Zip
Phone Number Extension
Kirkland WA 98033
2064862586
Contractor
Company Name
QUALTM
Number Street
Apartment or Suite Number
6917 120TH AVE NE
City State Zip
Phone Number Extension
Kirkland WA 98033
2064862586
State License Number License Expiration Date UBI #
E-mail Address
QUALT**846K7 5/29/2022 603620007
BOB@QUALTM.COM
Project Location
Number Street
Floor Number Suite or Room Number
21616 76TH AVE W
2 209
City Zip Code County Parcel Number
EDMONDS 98026 00461000100101
Associated Building Permit Number Tenant Name
Connect Inteqrative Medicine
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name
*
Number Street
PO BOX 92129
Last Name or Company Name
HR ACQUISITION I CORPORATION
Apartment or Suite Number
City State Zip
SOUTH LAKE TX 76092
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: 5/17/2022 Submitted By: Mohamadreza - Babak Mojarad
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CITY OF EDMONDS MyBui[di ngPerrnit.com
Building Application #1042979 - Edmonds Med
Project Contact
Company Name: QualTM General Construction
Name: Mohamadreza - Babak Mojarad Email: bob@qualtm.com
Address: 6917 120TH AVE NE Phone #: 2064862586
Kirkland WA 98033
Project Type
Nonresidential
Activity Type
Remodel
Project Name: Edmonds Med
Description of Work: Add an additional entry door to the suite
Project Details
Project Information
Square Feet -Tenant 1,280
Valuation
Fair Market Value of Construction Work $4,500
Exterior Changes?
The work does not involve changes to the exterior
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