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ENG2022-0554+Application+11.15.2022_4.34.24_PM+3221919CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1230382 - Edmonds Lot 3 Residence Applicant First Name Last Name Company Name Dante Palmaffy D. Palmaffy Desiqn Number Street Apartment or Suite Number E-mail Address 12925 47th Dr SE dpalmaffy(Daol.com City State Zip Phone Number Extension Everett WA 98208 (425) 345-2530 Contractor Company Name QUANTUM HOMES LLC Number Street Apartment or Suite Number 169th PI SW City State Zip Phone Number Extension Lynnwood WA 98037 2065717777 State License Number License Expiration Date UBI # E-mail Address QUANTHL806BW 2/5/2024 604423135 balwantaulck(Dgmail.com Project Location Number Street Floor Number Suite or Room Number 7901 240TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00452000400800 Associated Building Permit Number Tenant Name BLD2021-0811 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name TWIN PIER LLC Number Street Apartment or Suite Number PO BOX 55545 City State Zip SHORELINE WA 98155 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: 11/15/2022 Submitted By: Dante Palmaffy Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1230382 - Edmonds Lot 3 Residence Project Contact Company Name: D. Palmaffy Design Name: Dante Palmaffy Email: dpalmaffy@aol.com Address: 12925 47th Dr SE Phone #: (425) 345-2530 Everett WA 98208 Project Type Activity Type Scope of Work Single Family Residential New Side Sewer Connection Project Name: Edmonds Lot 3 Residence Description of Work: Sewer connection for new single family residence Project Details Structure Type Single Family Dwelling Project Information Connection to City sewer service Page 2 of 2