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ENG2023-0389_Application_7.28.2023_10.03.13_AM_3694649CITY OF EDMONDS M BuildingPermit.com Utilities Application #1354781 -Sue Delsignore Applicant First Name Last Name Company Name Aaron Palmen Roto Rooter Service Company Number Street Apartment or Suite Number E-mail Address 6321 7th Ave S. aaron.palmen@rrsc.com City State Zip Phone Number Extension Seattle WA 98108 (253) 405-7765 Contractor Company Name ROTO ROOTER SERVICES CO Number Street Apartment or Suite Number 6321 7th Ave S City State Zip Phone Number Extension Seattle WA 98108 (253) 405-7765 (253) 568-7100 State License Number License Expiration Date UBI # E-mail Address ROTORSC122BR 4/7/2024 F61 D57.1R1 aaron.palmen@rrsc.com Project Location Number Street Floor Number Suite or Room Number 1028 CASCADE LN City Zip Code County Parcel Number EDMONDS 98020 00548900001405 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 Susan Delsignore Number Street Apartment or Suite Number 1028 CASCADE LN City State Zip EDMONDS WA 98020 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: 7/28/2023 Submitted By: Aaron Palmen Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1354781 -Sue Delsignore Project Contact Company Name: Roto Rooter Service Company Name: Aaron Palmen Email: aaron.palmen@rrsc.com Address: 6321 7th Ave S. Phone #: (253) 405-7765 Seattle WA 98108 Project Type Activity Type Scope of Work Single Family Residential Utility Modification Partial Line Replacement Project Name: Sue Delsignore Description of Work: Emergency spot repair on existing side sewer. Up to 4' in length. All work on private property Project Details Structure Type Single Family Dwelling Project Information Repair Page 2 of 2