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Application_1326376CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1326376 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 22317 93RD PL W Floor Number Suite or Room Number City Zip Code EDMONDS 98020 County Parcel Number 00544300000801 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 Neil G Kappen Number Street 22317 93RD PL W Apartment or Suite Number City State EDMONDS WA Zip 98020 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: 6/2/2023 Submitted By: Kathleen Kappen Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1326376 Project Type Single Family Residential Project Details Appliances and Equipment Gas Piping Outlets - Mech Heaters Activity Type Repair or Replacement 4 Fireplace Insert - Gas 2 Associated Building Permit? There is no other onsite work that requires a building permit. Other Range 1 Work Location Work Description/Location (example: 1 st floor, interior of home Master Bath, Garage) Scope of Work Mechanical Page 2 of 2