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Application_BLD2023-0998CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1359608 Applicant First Name Last Name Brian Lee Company Name Sundance Energy Services Inc Number Street 10228 Main Street Apartment or Suite Number E-mail Address brianl@sundanceenergy.com City State Zip Bothell WA 98011 Phone Number Extension (425) 481-9660 Contractor Company Name Sundance Energy Services Inc Number Street 10228 Main Street Apartment or Suite Number City State Zip Bothell WA 98011 Phone Number Extension (425) 481-9660 State License Number License Expiration Date SUNDAES063J9 9/13/2023 UBI # E-mail Address BD15416:37 kevinl@sundanceenergy.com Project Location Number Street 21717 95TH AVE W Floor Number Suite or Room Number City Zip Code EDMONDS 98020 County Parcel Number 00527900002402 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 Sherman Jancie M Lind Number Street 21717 95TH AVE W Apartment or Suite Number City State EDMONDS WA Zip 98020-3913 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: 8/8/2023 Submitted By: Brian Lee Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1359608 Project Type Single Family Residential Project Details Heaters Fireplace Insert - Gas Associated Building Permit? Activity Type Repair or Replacement There is no other onsite work that requires a building permit. Work Location Scope of Work Mechanical Work Description/Location (example: 1st floor, Replacing a gas fireplace insert in family room Master Bath, Garage) Page 2 of 2