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ENG2022-0536_Application_11.2.2022_8.29.24_AM_2659060CITY OF EDMONDS M BuildingPermit.com Utilities Application #1086818 - Shippen Applicant First Name Last Name Company Name Jim Coolbaugh Bodine construction Services, Inc Number Street Apartment or Suite Number E-mail Address 6009 212th st sw jim@bodineconstruction.com City State Zip Phone Number Extension Lynnwood WA 98036 (425) 778-2557 Contractor Company Name BODINE CONSTR CO INC Number Street Apartment or Suite Number 6009 212th st sw City State Zip Phone Number Extension Lynnwood Wa 98036 (425) 778-2557 (206) 510-5482 State License Number License Expiration Date UBI # E-mail Address BODINC*332BT 3/2/2023 11 gnnss.m jim@bodineconstruction.com Project Location Number Street Floor Number Suite or Room Number 18101 SUNSET WAY City Zip Code County Parcel Number EDMONDS 98026 27041800202000 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 Matthew & Elana Shippen Number Street Apartment or Suite Number 18101 SUNSET WAY City State Zip EDMONDS WA 98026 Certification Statement - The applicant states: I 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. I 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: 11/2/2022 Submitted By: Jim Coolbaugh Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1086818 - Shippen Project Contact Company Name: Bodine construction Services, Inc Name: Jim Coolbaugh Email: jim@bodineconstruction.com Address: 6009 212th st sw Phone #: (425) 778-2557 Lynnwood WA 98036 Project Type Activity Type Scope of Work Single Family Residential Utility Modification Storm Drainage System Project Name: Shippen Description of Residential storm drainage repair. Repair/Replace below grade downspout and footing Work: conveyance pipes. New conveyance pipe to connect to existing Type 1 catch basin #5-473. Project Details Project Information Connection to City stormwater system Page 2 of 2