Application_BLD2023-0618CITY OF EDMONDS M BuildingPermit.com
Plumbing Application #1319204
Applicant
First Name Last Name Company Name
Laurel Fortney
Number Street Apartment or Suite Number E-mail Address
6909 174th Street SW lifortney@me.com
City State Zip Phone Number Extension
Edmonds WA 98026 (425) 599-5139
Contractor
Company Name
Owner
Number Street Apartment or Suite Number
City State Zip Phone Number Extension
State License Number License Expiration Date UBI # E-mail Address
Project Location
Number Street Floor Number Suite or Room Number
6909 174TH ST SW
City Zip Code County Parcel Number
EDMONDS 98026 00513100014523
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
Laurel I Fortney
Number Street Apartment or Suite Number
6909 174TH ST SW
City State Zip
EDMONDS WA 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: 5/19/2023 Submitted By: Laurel Fortney
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CITY OF EDMONDS MyBuildingPermit.com
Plumbing Application #1319204
Project Type
Single Family Residential
Project Details
Activity Type
Repair or Replacement
Scope of Work
Like for like equipment in the same location
Piping
Piping - Water Service
Associated Building Permit?
There is no other onsite work that requires a building
permit.
Work Location
Work Description/Location (example: 1 st floor, Outside of the house
Master Bath, Garage)
Scope of Work
Plumbing
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