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Application_1561973CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1561973 Applicant First Name Last Name Company Name Amy Revelle Ballard Natural Gas Service Number Street Apartment or Suite Number E-mail Address 2027 196th St SW A101 permits@ballardnaturalgas.com City State Zip Phone Number Extension Lynnwood WA 98036 (206) 784-8101 Contractor Company Name BALLARD NATURAL GAS SRVC INC Number Street Apartment or Suite Number 2027 196th St SW A101 City State Zip Phone Number Extension Lynnwood WA 98036 (206) 784-8101 State License Number License Expiration Date UBI # E-mail Address BALLANG062QD 12/6/2025 BD15nR.147 permits@ballardnaturalgas.com Project Location Number Street Floor Number Suite or Room Number 23105 99TH AVE W City Zip Code County Parcel Number EDMONDS 98020 00391400001800 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 Jesse J & Vanni Olivia G Flickinger Number Street Apartment or Suite Number 242 ELM ST City State Zip EVERETT WA 98203 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent, including an appropriately licensed contractor. I have furnished true and correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above may result in revocation of the permit. Date Submitted: 10/15/2024 Submitted By: Amy Revelle Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1561973 Project Type Activity Type Scope of Work Single Family Residential Repair or Replacement Mechanical Project Details HVAC Systems Furnace Work Location Work Description/Location (example: 1st floor, Basement Master Bath, Garage) Page 2 of 2