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Application_BLD2023-0946CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1354335 Applicant First Name Last Name Company Name Michael Kiselman Number Street Apartment or Suite Number E-mail Address 1123 Emerald Hills Drive limitlessplumbing247@gmail.com City State Zip Phone Number Extension Edmonds WA 98020 (425) 870-2946 Contractor Company Name Owner Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 1123 EMERALD HILLS DR City Zip Code County Parcel Number EDMONDS 98020 00423000002700 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 Mikhail & Yelena Kiselman Number Street Apartment or Suite Number 1123 EMERALD HILLS DR City State Zip EDMONDS WA 98020 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent, including an appropriately licensed contractor. I have furnished true and correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above may result in revocation of the permit. Date Submitted: 7/27/2023 Submitted By: Michael Kiselman Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1354335 Project Type Single Family Residential Project Details Piping Piping - Water Service Associated Building Permit? Activity Type Repair or Replacement There is no other onsite work that requires a building permit. Work Location Scope of Work Plumbing Work Description/Location (example: 1 st floor, Repair on water service line outside house only. Master Bath, Garage) Page 2 of 2