BLD2023-0663_Application_5.31.2023_9.43.34_AM_3577639CITY OF EDMONDS MyBuildingPermit.com
Mechanical Application #1324759 - PARKS MECH
Applicant
First Name Last Name Company Name
jason burge Black Lion Heating and Air Conditioning
Number Street Apartment or Suite Number E-mail Address
11001 118th pl ne info@blacklionhvac.com
City State Zip Phone Number Extension
KIRKLAND WA 98033 (425) 814-3944
Contractor
Company Name
BLACK LION HEATING & A/C LLC
Number Street Apartment or Suite Number
11001 118th PL NE
City State Zip Phone Number Extension
KIRKLAND WA 98033 (425)814-3944
State License Number License Expiration Date UBI # E-mail Address
BLACKLH873QQ 11/18/2023 Rnimsggn info@blacklionhvac.com
Project Location
Number Street Floor Number Suite or Room Number
21909 93RD AVE W
City Zip Code County Parcel Number
EDMONDS 98020 00373600701406
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 Parks
Number Street Apartment or Suite Number
21909 93RD AVE W
City State Zip
EDMONDS WA 98020-3941
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: 5/31/2023 Submitted By: jason burge
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CITY OF EDMONDS M BuildingPermit.com
Mechanical Application #1324759 - PARKS MECH
Project Contact
Company Name: Black Lion Heating and Air
Conditioning
Name: jason burge Email: info@blacklionhvac.com
Address: 11001 118th pl ne Phone #: (425) 814-3944
KIRKLAND WA 98033
Project Type Activity Type Scope of Work
Single Family Residential Repair or Replacement Mechanical
Project Name: PARKS MECH
Description of Work: HP - M#38MARBQ36
Project Details
HVAC Systems
Heat Pump 1
Associated Building Permit?
There is no other onsite work that requires a building
permit.
Work Location
Work Description/Location (example: 1st floor, OUTSIDE
Master Bath, Garage)
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