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BLD2024-0860_Application_7.1.2024_3.39.37_PM_4353400CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1511935 - Hot water tank Applicant First Name Last Name Company Name Harald Domke Number Street Apartment or Suite Number E-mail Address 510 Forsyth Ln 409 hgdomke@frontier.com City State Zip Phone Number Extension Edmonds WA 98020 (206) 409-6967 Contractor Company Name e-z way plumbing LLC Number Street Apartment or Suite Number 17462 160th st se City State Zip Phone Number Extension monroe wa 98272 (425) 214-3776 State License Number License Expiration Date UBI # E-mail Address EZWAYWP799RF 2/24/2026 FD9gRiss4 hgdomke@frontier.com Project Location Number Street Floor Number Suite or Room Number 510 FORSYTH LN 4 409 City Zip Code County Parcel Number EDMONDS 98020 00762400040900 Associated Building Permit Number Tenant Name 1 Harald Domke Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Harold G & Jeanene M Domke Number Street Apartment or Suite Number 1837 SEAWARD WAY City State Zip COUPEVILLE WA 98239 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: 7/1/2024 Submitted By: Harald Domke Page 1 of 2 i CITY OF EDMONDS MyBuitdingPermit.com Plumbing Application #1511935 - Hot water tank Project Contact Company Name: Name: Address: Harald Domke 510 Forsyth Ln 409 Edmonds WA 98020 Project Type Multifamily Residential Email: hgdomke@frontier.com Phone #: (206) 409-6967 Activity Type Repair or Replacement Project Name: Hot water tank Description of Work: Hot water tank replacement Project Details Scope of Work Like for like equipment in the same location Associated Building Permit? There is no other onsite work that requires a building permit. Additional Project Information Total number of fixtures being added or altered Work Location Work Description/Location (example: 1st floor, Master Bath, Garage) Work to be performed by a licensed contractor Yes 1 Scope of Work Plumbing 4th floor, Master bedroom closet Page 2 of 2