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BLD2023-1176_Application_9.17.2023_9.08.36_PM_3787639CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1377279 - New House Plumbing Applicant First Name Last Name Company Name Ricardas Vaisvila Number Street Apartment or Suite Number E-mail Address 17123 69th PI W richardvaisvila@comcast.net City State Zip Phone Number Extension Edmonds WA 98026 (425) 299-1739 Contractor Company Name Contractor Unknown Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 17125 69TH PL W City Zip Code County Parcel Number EDMONDS 98026 01017300001200 Associated Building Permit Number Tenant Name BLD2022-0094 Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Ricardas Vaisvila Number Street Apartment or Suite Number 17125 69TH PL W City State Zip EDMONDS WA 98026 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: 9/17/2023 Submitted By: Ricardas Vaisvila Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1377279 - New House Plumbing Project Contact Company Name: Name: Address: Ricardas Vaisvila 17123 69th PI W Edmonds WA 98026 Project Type Single Family Residential Email: richardvaisvila@comcast.net Phone #: (425) 299-1739 Activity Type Scope of Work New Plumbing Project Name: New House Plumbing Description of Work: Install DWV and domestic water lines for new home Project Details Scope of Work Plumbing Fixtures for Building Permit Fixtures Clothes Washer 1 Dishwasher 1 Hose Bib 3 Ice Maker 1 Pressure Reducing Valve - Plum 1 Shower, Tub or Combo 3 Toilet 4 Water Heater - Tankless 1 Sinks Sink 7 Piping Gas Piping Outlets - Plum 5 Piping - Water Service Water Supply Piping 1 Associated Building Permit? There is or will be a building permit associated with this work at the project location. Other BLD2022-0094 1 Work Location Work Description/Location (example: 1 st floor, New SFR under construction Master Bath, Garage) Page 2 of 2