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' DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, Si DEMOLITION
PERMIT APPLICATION
ist 1 9° 121 5th Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street. Suite #, City State, Zip).
Parcel #:
8708 OLYMPIC VIEW DR, EDMONDS, WA 98026-5319
00434600000410
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes No
Associated Permit #:
APPLICANT:
Phone:
Fax:
TANKS BY DALLAS
206-365,0291
206.361.0992
Address (Street, City, State, Zip):
E-Mail Address:
17552 BALLINGER WAY NE LFP, WA 98155
TANKSBYDALLAS@TANKSBYDALLAS.NET
PROPERTY OWNER:
Phone:
Fax:
DELGADO ROSANN DOREEN
N/A
Address (Street, City, State, Zip):
E-Mail Address:
8708 OLYMPIC VIEW DR, EDMONDS, WA 98026.5319
LENDING AGENCY:
Phone:
Fax:
NONE
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
TANKS BY DALLAS
206.365.02914
1206,361-0992
Address (Street, City, State, Zip):
E-Mail Address:
17552 BALLINGER WAY NE LFP, WA 98155
TANKSBYDALLAS@TANKSBYDALLAS. NET
*Contractor must have a valid City of Edmonds bit, iness license prior to doing work
in the City. Contact the City Clerk's
WA State License #/Exp. Date:
TANKSD'001 KF
City Business License#/Exp, Date:
Office at425.775.2525
N R-025038
PLUMBING I MECHANICAL I TANK M DEMOLITION
DETAIL THE SCOPE OF WORK: Pump, Triple -rinse, removal and disposal of (1) 500 gallon
UST.
I declare underpenalty of perjury laws that the itt�'ormation I have provided on this formlapplication is true, correct and complete,
and that I am the property owner or duly authorized agent of the property owner to submit a permit application to the City of
Unronds.
Print Name: VON DALLAS GIGRIC,H Owner❑ Agent/Other (specify): contractor
Signature: I Date: 03/21 /2019
FORM C LABuilding New Folder 2010XDONE & x4etret to L-Building-New driveTorm C 2014.docx Updated: 1/17/2014
TANK #1
TANK #2
Method of Abandonment
Method of Abandonment
Fill in Place ❑ Fill Material
Fill in Place ❑
Fill Material
Removal ❑
Removal ❑
Number of Gallons: 300-GALLON
Number of Gallons:
Critical Areas Determination: Study Required ❑
Conditional Waiver ❑
Waiver ❑
Type of structure to be demolished (e.g. house, shed, garage, etc.):
Floor area of structure to be demolished:
Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑
PSCAA Case No.
AHERA Survey done? (required) ❑
Additional comments:
FORM C LABuilding New Folder 20101DONE & x-l'crretl to L-Building-New drivelForm C 201 a.docx Updated: 1/17/2014
BID LOCATE SOIL SAMPLES FILL
REC SEARCH COMPLETED TREMO�AL
NAME_
DATE
SITE ADDRESS u &M () M
PHONE *"REFERRED BY
'EMAIL
o • Co rv)
ANIMALS YIN VACANT Y N
TANK SIZE Co0Q FILL PIPE: i
LAY OF TANK FILL GRADE
CONTENTS OIL WATER
WHAT TRUCKS CAN WE BRING TO THIS SITE?
OFFICE NOTES: Y\M-A X In A/
FIELD MOTES:
Y
JOB,CQMPLETED,'BY:
Site info taken by:—��
,Uv l,G -S-�- Co lc,
WATER YIN POWER YIN
DIAMETER _'�� TOTAL
LENGTH G
GROUND COVER F- A K i�
OTHER
.TOTAL (, "
ove
Y
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APPWVjD
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DATE:
fieadiine lll�
`� or r:Y °ems
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
/Ale ' gq0 PHONE: (425) 771-0220 -FAX: (425) 771-0221
Thursday, March 21, 2019
Your Application has been accepted by the City of Edmonds and we will start the application process with the
information you provided. More information and changes may be required during this process. The decision target
date is .
Application Number: CRA20190046
Project Address: 8708 OLYMPIC VIEW DR, EDMONDS
ROSANN DORREN DELGADO
8708 OLYMPIC VIEW DR
EDMONDS, WA 98026-5319
ROSANN DORREN DELGADO
8708 OLYMPIC VIEW DR
EDMONDS, WA 98026-5319
To view up to date information about your permit please visit the City of Edmonds Development Services website
at http://www.ci.edmonds.wa.us.