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BLD2023-1547_Application_12.4.2023_12.09.17_PM_3931919CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1412226 - Edmonds Water leak Applicant First Name Last Name Company Name Charles LeFevre Number Street Apartment or Suite Number E-mail Address 926 Olympic Avenue chuckl@esquin.com City State Zip Phone Number Extension Edmonds WA 98020 (206) 459-0485 Contractor Company Name Owner 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 926 OLYMPIC AVE City Zip Code County Parcel Number EDMONDS 98020 00548900002003 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 Charles Lefevre Number Street Apartment or Suite Number PO BOX 3791 City State Zip SEATTLE WA 98124 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: 12/4/2023 Submitted By: Charles LeFevre Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1412226 - Edmonds Water leak Project Contact Company Name: Name: Charles LeFevre Email: chuckl@esquin.com Address: 926 Olympic Avenue Phone #: (206) 459-0485 Edmonds WA 98020 Project Type Activity Type Scope of Work Single Family Residential Repair or Replacement Plumbing Project Name: Edmonds Water leak Description of Work: Replace broken pipe Project Details Scope of Work Like for like equipment in the same location Piping Water Supply Piping 1 Work Location Work Description/Location (example: 1 st floor, Outside SW corner of lot Master Bath, Garage) Existing Permits There is or will be a building permit associated with this work at the project location. Page 2 of 2