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BLD2022-0769+Application+6.13.2022_12.10.07_PM+2928283CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1157973 - N FIRDALE VILLAGE / DENTAL Applicant First Name Last Name Company Name Ruth Sequra Synerqy Number Street Apartment or Suite Number E-mail Address 7542 Woodley Ave rsequra(c.synergy.cc City State Zip Phone Number Extension Van Nuys CA 91406 (661) 754-1282 Contractor Company Name Contractor Unknown Number Street Apartment or Suite Number City State License Number Project Location State Zip License Expiration Date UBI # Number Street 10014 238TH ST SW City Zip Code County Parcel Number EDMONDS 98020 00615800000100 Associated Building Permit Number Tenant Name BLD20150924 Vacant Additional Information (i.e. equipment location or special instructions). Work Location Property Owner Phone Number Extension E-mail Address Floor Number Suite or Room Number 1 None First Name Last Name or Company Name Thomas & Phan Quyen Sawyer Number Street Apartment or Suite Number 1005 196TH PL SW City State Zip LYNNWOOD WA 98036-7188 Certification Statement - The applicant states: 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. 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: 6/13/2022 Submitted By: Ruth Segura Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Mechanical Application #1157973 - N FIRDALE VILLAGE / DENTAL Project Contact Company Name: Synergy Name: Ruth Segura Address: 7542 Woodley Ave Van Nuys CA 91406 Project Type Nonresidential Email: rsegura@synergy.cc Phone #: (661) 754-1282 Activity Type Alteration Project Name: N FIRDALE VILLAGE / DENTAL Scope of Work Mechanical MODIFICATION TO EXISTING CELL TOWER SCOPE OF WORK: 1. INSTALL (1) 48kW Description of DIESEL GENERATOR WITH 240 GALLON BELLY TANK ON PROPOSED 4'-0"x9'-0" Work: CONCRETE PAD 2. INSTALL (1) 200A AUTOMATIC TRANSFER SWITCH ON EXISTING BACKBOARD 3. INSTALL SITE SIGNAGE 4. INSTALL BRANCH CIRCUITS TO GENERATOR Project Details Scope of Work Mech Equipment Per Plans Appliances and Equipment LPG 125 to 250 gallon tanks Associated Building Permit? There is no other onsite work that requires a building permit. Work Location Work Description/Location (example: 1 st floor, Master Bath, Garage) 1 Modification to existing T-Mobile wireless unmanned telecommunications Facility: 1. INSTALL (1) 48kW DIESEL GENERATOR WITH 240 GALLON BELLY TANK ON PROPOSED 4'-0"x9'-0" CONCRETE PAD 2. INSTALL (1) 200A AUTOMATIC TRANSFER SWITCH ON EXISTING BACKBOARD 3. INSTALL SITE SIGNAGE 4. INSTALL BRANCH CIRCUITS TO GENERATOR Page 2 of 2