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CITY OF EDMONDS <br />Mechanical Application #952865 <br />Applicant <br />First Name Last Name <br />Ivan Baka <br />Company Name <br />Five Star Comfort, LLC <br />Number Street <br />2209 Bedalln <br />Apartment or Suite Number E-mail Address <br /> <br />City State Zip <br />Everett WA 98208 <br />Phone Number Extension <br />(425) 344-5438 <br />Contractor <br />Company Name <br />FIVE STAR COMFORT LLC <br />Number Street <br />2209 Bedalln <br />Apartment or Suite Number <br />City State Zip <br />Everett WA 98208 <br />Phone Number Extension <br />(425) 344-5438 <br />State License Number License Expiration Date <br />FIVESSC881 L2 6/22/2022 <br />UBI # E-mail Address <br />F;n19nR7l R <br />Project Location <br />Number Street <br />22423 100TH AVE W <br />Floor Number Suite or Room Number <br />City Zip Code <br />EDMONDS 98020 <br />County Parcel Number <br />00450700500014 <br />Associated Building Permit Number <br />Tenant Name <br />Additional Information (i.e. equipment location or special instructions)_ <br />Work Location <br />Property Owner <br />First Name Last Name or Company Name <br />Richard A & Cynthia A Tomkins <br />Number Street <br />211 5TH AVE N <br />Apartment or Suite Number <br />City State <br />EDMONDS WA <br />Zip <br />98020 <br />Certification Statement - The applicant states: <br />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 <br />correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By <br />submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above <br />may result in revocation of the permit. <br />Date Submitted: 4/21/2021 Submitted By: Ivan Baka <br />Page 1 of 2 <br />