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ENG2024-0304+Application+6.17.2024_11.49.02_AM+4326695CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1499536 - DRT 212th Side Sewer Applicant First Name Last Name Company Name Lauren Golembiewski DRT Holdinqs LLC Number Street Apartment or Suite Number E-mail Address 7509 212th ST SW LMiles(aglacierenviro.com City State Zip Phone Number Extension Edmonds WA 98026 (425) 355-2826 Contractor Company Name GLACIER ENVIRONMENTAL SRVC INC Number Street Apartment or Suite Number 7509 212th ST SW City State Zip Phone Number Extension Edmonds WA 98275 (425) 355-2826 State License Number License Expiration Date UBI # E-mail Address GLACIES108C7 1/14/2026 601225417 LMiles(aD_glacierenviro.com Project Location Number Street Floor Number Suite or Room Number 7509 212TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00566900400600 Associated Building Permit Number Tenant Name BLD2022-1556 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name DRT HOLDINGS, LLC Number Street Apartment or Suite Number 7509 212TH PL SW City State Zip EDMONDS WA 98026 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: 6/17/2024 Submitted By: Lauren Golembiewski Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1499536 - DIRT 212th Side Sewer Project Contact Company Name: DIRT Holdings LLC Name: Lauren Golembiewski Email: LMiles@glacierenviro.com Address: 7509 212th ST SW Phone #: (425) 355-2826 Edmonds WA 98026 Project Type Activity Type Scope of Work Nonresidential New Side Sewer Connection Project Name: DIRT 212th Side Sewer Description of Connect new 6" side sewer to the main in an existing manhole. Follow the same path and Work: the now decommissioned side sewer. Plans and details are shown in the Plan Set with associated permit 2022-1556 Project Details Project Information Connection to City sewer service Page 2 of 2