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BLD2023-1538_Application_11.30.2023_1.11.49_PM_3926869CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1411064 - Water main line leak repair Applicant First Name Last Name Company Name Gene Merlino Number Street Apartment or Suite Number E-mail Address 19927 81st PI W glmerlino@yahoo.com City State Zip Phone Number Extension Edmonds WA 98026 (619) 861-1245 Contractor Company Name Mill Creek Plumbing Number Street Apartment or Suite Number 914 164th St SE #286 City State Zip Phone Number Extension Mill Creek WA 98012 (425) 670-8818 State License Number License Expiration Date UBI # E-mail Address MILLCP*926NE 9/5/2024 FD9DiSR9 1 glmerlino@yahoo.com Project Location Number Street Floor Number Suite or Room Number 19927 81ST PL W City Zip Code County Parcel Number EDMONDS 98026 00603400000100 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 Gene & Anderson Gwen Merlino Number Street Apartment or Suite Number 19927 81ST 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: 11/30/2023 Submitted By: Gene Merlino Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1411064 - Water main line leak repair Project Contact Company Name: Name: Address: Gene Merlino 19927 81 st PI W Edmonds WA 98026 Email: glmerlino@yahoo.com Phone #: (619) 861-1245 Project Type Activity Type Scope of Work Single Family Residential Repair or Replacement Plumbing Project Name: Water main line leak repair Description of Work: Repair leak in water line that goes from main source to house. Project Details Scope of Work Like for like equipment in the same location Piping Water Line Re -Pipe Work Location Work Description/Location (example: 1st floor, Master Bath, Garage) Existing Permits There is no other onsite work that requires a building permit. Outside water line from main to house. South side of house next to tree stump. Page 2 of 2