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ENG2024-0175+Application+4.18.2024_12.22.25_PM+4205232CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1475666 - Rust Addition Side Sewer Repair Applicant First Name Last Name Company Name James Rust Number Street Apartment or Suite Number E-mail Address 19803 81 st PI W james(LD_tri-countycabulance.com City State Zip Phone Number Extension Edmonds WA 98026 (206) 571-2279 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 19803 81 ST PL W City Zip Code County Parcel Number EDMONDS 98026 00603400000900 Associated Building Permit Number Tenant Name BLD2023-1095 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 First Name Last Name or Company Name James C & Heather L Rust Number Street Apartment or Suite Number 19803 81 ST PL W City State Zip EDMONDS WA 98026-6410 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: 4/18/2024 Submitted By: James Rust Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1475666 - Rust Addition Side Sewer Repair Project Contact Company Name: OMEGA ENGINEERIING Name: Ali Maggs Email: ALI@OMEGA-ENG.COM Address: 2707 WETMORE AVE Phone #: (425) 903-4852 EVERETT WA 98201 Project Type Activity Type Single Family Residential Utility Modification Project Name: Rust Addition Side Sewer Repair Description of Work: Relocate Side Sewer to North side of SFR Project Details Structure Type Single Family Dwelling Project Information Repair Scope of Work Partial Line Replacement Page 2 of 2