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BLD2022-0862+Application+6.30.2022_4.04.10_PM+2965578CITY OF EDMONDS Building Application #1167301 - Office retrofit Applicant First Name Last Name Thom Sullivan Number Street Apartment or Suite Numt 7110 210 st. SW City State Zip Edmonds WA 98026 Contractor Company Name Contractor Unknown Number Street City State Zip State License Number License Expiration Date UBI # Project Location MyBuildingPermit.com Company Name City of Edmonds or E-mail Address thom.sullivan(a-)-edmondswa.gov Phone Number Extension (425) 760-3334 Apartment or Suite Number Phone Number Extension E-mail Address Number Street Floor Number Suite or Room Number 700 MAIN ST 1 115/121 City Zip Code County Parcel Number EDMONDS 98020 00434208800000 Associated Building Permit Number Tenant Name City of Edmonds Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name EDMONDS CITY OF Number Street Apartment or Suite Number 250 5TH AVE N City State Zip EDMONDS WA 98020-3146 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: 6/30/2022 Submitted By: Thom Sullivan Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Building Application #1167301 - Office retrofit Project Contact Company Name: City of Edmonds Name: Thom Sullivan Email: thom.sullivan@edmondswa.gov Address: 7110 210 st. SW Phone #: (425) 760-3334 Edmonds WA 98026 Project Type Nonresidential Activity Type Tenant Improvement - Change of Use Project Name: Office retrofit Description of Work: Convert two existing classrooms to office space Project Details Project Information Square Feet -Tenant 2,000 Use Information Use - existing Classroom/assembly Use - proposed Office Work Location Work Description/Location (example: 1 st floor, 100 level floor Master Bath, Garage) Page 2 of 2