20160517124256.pdfDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5h Avenue N, Edmonds, WA 98020
t Phone 425.771.0220 2 Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PL UMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
8027 218th St SW, Edmonds, WA 98026 27043000100700
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes❑ No�
APPLICANT: Phone: =-548-9352 Filco Company Inc. 206-547-8347
Address (Street, City, State, Zip): E -Mail Address:
PO Box 31228 Seattle, Washington 98103 info@filcoenviro.com
PROPERTY OWNER: Phone: Fax:
Chris Minor 425-870-2351
Address (Street, City, State, Zip): E -Mail Address:
8027 218th St SW Edmonds, WA 98026 n/a
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
CONTRACTOR:* Phone: Fax:
Filco CQMany Inc. 206-547-8347 06-548-9352
Address (Street, City, State, Zip): E -Mail Address:
PO Box 31228 Seattle Washington 98103 info@filcoenviro.com
WA State License #/Exp. Late:
Contractor must have a valid City trfEdrionds business license prior to doing work FILCOCIO8 RU .10/10/2015
in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Ex. ate:
NR -0205 1�231 /2016
PLUMBING MECHANICAL TANK yi _ DEMOLITION LIJ
DETAIL THE SCOPE OF WORK: Pump, rinse and fill in place with foam, one 300 gallon
residential heating oil tank. Cut vent and fill pipe below grade.
I declare under lrena/l r ofperjury Imsw s that the info rrnatdan I haw+e provided an thisforntlapr)lieation is true, correct and" coinplete;,
and that I am the Pro; erty owner or duly authorised agent of the Property owner to submit a pertnit applicatlon to the City o,
Edmonds.
Print Name7-/-;M .4(f1ge-s Owner ❑ Agent/Other ❑✓ (specify): Contractor
Si' store: Date:
FOR M C. T -M, lAin. Mpu PM,1—')AI A\Tl(TMF R..._fn d t.. T _R,,;IA;n ATP„ 0 P)M A TT 1 11 —1 1
Type of Gas/Air/Vacuum System (new and relocated) Total#
Oxygen
Nitrous Oxide
Medical Air
—
Carbon Dioxide
Helium
Medical — Surgical Vacuum
Other:
TOTAL OUTLETS
TANK #1
TANK #2
Method of Abandonment
Method of Abandonment
Fill in Place"
Fill Material
Fill in Place
Fill Material
RemovalRemoval
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:
sq. ft.
Critical Areas Determination: Study Required El
Conditional Waiver El WaiverEl
PSCAA Case No.
AH1A Survey done? (required) El
Additional comments:
' nu'KIf (' t An..:ia:_.. wT-... I. -I r_— ._ r n._a tee__ IT_._. �-_._w_— n nn. a __ 11...;r..:. , « .« ....
FILCO COMPANY INC. LICENSE#FILCOCI080RU EXP:10/10/2017
PO BOX 31228 ICC LICENSE # 5050940....
SEATTLE, WA 98103
SITE PLAR
AEATING OIL TANK DECOMMISSIONIM
JOB SITE ADRESS: 8027 218T11 ST SVS?, EDMONDS WA 98028
OWNER: CHRIS MINOR.
PHONE: 425-870-2351
ACTIVITY: Pump, rinse & fill in place foam, one 300 gallon residential heating oil tank. Cut fill pipe and vent
pipe below grade and cap.
218TH STREET SW