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FIR2023-0062+Application+6.13.2023_12.12.50_PM+3606092CITY OF EDMONDS Fire Application #1332332 - 19512 Select Applicant First Name Last Name BRENT BESANCON MyBuildingPermit.com Company Name NW Custom Plumbinq Number Street Apartment or Suite Number E-mail Address 17146 Britt Rd City State Zip Mount Vernon WA 98273-6598 Contractor Company Name NW Custom Plumbinq LLC Number Street 3405 172nd st ne City State Zip Arlinqton WA 98223 State License Number License Expiration Date UBI # NWCUSCP791RM 1/24/2024 603373451 Project Location Number Street 19510 88TH AVE W brent.nwcp(D_outlook.com Phone Number Extension (206) 660-7442 Apartment or Suite Number 5-158 Phone Number Extension (206) 660-7442 E-mail Address brent.nwcp(c_outlook.com City Zip Code County Parcel Number EDMONDS 98026 27041800303400 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Floor Number Suite or Room Number First Name Last Name or Company Name SELECT HOMES INC Number Street Apartment or Suite Number 16531 13TH AVE W A107 City State Zip LYNNWOOD WA 98037 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: 6/13/2023 Submitted By: BRENT BESANCON Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Fire Application #1332332 - 19512 Select Project Contact Company Name: NW Custom Plumbing Name: JACOB BRUNS Email: jake.nwcp@outlook.com Address: 17146 Britt Rd Phone #: (425) 327-4101 Mount Vernon WA 98273-6598 Project Type Single Family Residential Activity Type Scope of Work New Fire Sprinkler Systems Project Name: 19512 Select Description of Work: Installation of 13D Fire suppression Project Details Fire System Type NFPA 13D Contact Information Owner Email Address jake.nwcp@outlook.com Page 2 of 2