ENG2022-0446+Application+9.2.2022_11.05.02_AM+3088183CITY OF EDMONDS MyBuilaingPermit.coin
Utilities Application #1196908 - Lang Residence Addition
Applicant
First Name Last Name Company Name
tuvia poliskin T2 Design
Number Street Apartment or Suite Number E-mail Address
19219 51 st Ave NE t(�D_tuviapoliskin.com
City State Zip Phone Number Extension
Lake Forest Park Wa 98155-2940 (425) 395-4861
Contractor
Company Name
Contractor Unknown
Number Street
City
State License Number
Project Location
State Zip
License Expiration Date UBI #
Number Street
19637 80TH PL W
City Zip Code County Parcel Number
EDMONDS 98026 00506400000900
Associated Building Permit Number Tenant Name
BLD2022-0628
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
Apartment or Suite Number
Phone Number Extension
E-mail Address
Floor Number Suite or Room Number
First Name Last Name or Company Name
John Wesley & Sara Lanq
Number Street Apartment or Suite Number
19637 80TH PL W
City State Zip
EDMONDS WA 98026-6404
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: 9/2/2022 Submitted By: tuvia poliskin
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Utilities Application #1196908 - Lang Residence Addition
Project Contact
Company Name: T2 Design
Name: tuvia poliskin Email: t@tuviapoliskin.com
Address: 19219 51st Ave NE Phone #: (425) 395-4861
Lake Forest Park Washington
98155-2940
Project Type Activity Type
Single Family Residential Utility Modification
Project Name: Lang Residence Addition
Description of Work: Relocating Sewer Cleanout on private property
Project Details
Structure Type
Single Family Dwelling
Project Information
Relocate
Scope of Work
Partial Line Replacement
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