FIR2021-0069+Application+7.12.2021_9.46.01_AM+2294473CITY OF EDMONDS nnysuilaingPermit.com
Fire Application #989529 - Lawrence
Applicant
First Name Last Name Company Name
Kelly Mackay LEFT COAST SERVICES LLC
Number Street Apartment or Suite Number E-mail Address
126 SW 148th St Suite C100 Box 4 uai kwm anyahoo.com
City State Zip
Burien WA 98166
Contractor
Company Name
LEFT COAST SERVICES LLC
Number Street
126 SW 148TH ST STE C100 BOX 4
City State Zip
BURIEN WA 98166
State License Number License Expiration Date UBI #
LEFTCCS829QB 11/3/2022 604267785
Project Location
Phone Number Extension
2067627500
Apartment or Suite Number
Phone Number Extension
(206)762-7500
E-mail Address
uai kwm@yahoo.com
Number Street Floor Number Suite or Room Number
21709 82ND AVE W
City Zip Code County Parcel Number
EDMONDS 98026 00534600000700
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
Richard Lawrence
Number Street Apartment or Suite Number
21709 82ND AVE W
City State Zip
EDMONDS WA 98026-7811
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: 7/12/2021 Submitted By: Kelly Mackay
Page 1 of 2
i
CITY OF EDMONDS MyBui[di ngPerrnit.com
Fire Application #989529 - Lawrence
Project Contact
Company Name: LEFT COAST SERVICES LLC
Name: Kelly Mackay Email: uai_kwm@yahoo.com
Address: 126 SW 148th St Suite C100 Box 4 Phone #: 2067627500
Burien WA 98166
Project Type Activity Type Scope of Work
Single Family Residential Decommission Underground Storage Tank Removal
Project Name: Lawrence
Description of Work: Remove 300 gallon Underground Residential Heating Oil Tank.
Project Details
Type of Work
Tank Removal
Page 2 of 2