20170602142359.pdf' tp DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 50 Avenue N, Edmonds, WA 98020
Phone 425.771.0220 It Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & ME�HANJCAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
100 14 238th St SW, Edmonds, WA 98020
00615800000100
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? YesE] N o Fy/1
Associated Permit #:
APPLICANT:
Phone:
Seattle Tank Services
206-938-2280
67
Address (Street, City, State, Zip):
E-Mail Address:
PO Box 31516 Seattle, Washington 98103
info@seattletank.com
PROPERTY OWNER:
Phone:
Thomas Sawyer
425-330-7440
Address (Street, City, State, Zip):
E-Mail Address:
100 14 2 38th St SW, Edmonds, WA 98020
twainRuV@hotmail.com
LENDING AGENCY:
Phone:
Address (Street, City, State, Zip):.
E-Mail Address:
CONTRACTOR:*
Phone:
Fax:
Seattle Tank Services
206-938-2280
106-933-1967
Address (Street, City, State, Zip):
E-Mail Addkess:
PO Box 31516. Seattle. Washington 98103
info@seattletank.com
WA State License #/Exp. Dat7:
SEATTT`T0 I 2Q4 11 19/2016
*Contractor must have a valid City ofEdmonds business license prior to doing work
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/E
INR-02059J 12 ��- F16 17
PLUMBINGH MECHANICAL I I
TANK I,/ I DEMOLITION I
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 penalty ofperjury laws that the information I have provided on thisform/application is true, correct and complete,
and that I am the property owner or duty authorized agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: -1,-Im OwnerEl
Agent/Otber Z (specify): Contractor
Signature: e5��7 Date:
-7
FORMC.
MEDICNDGAS, AIR,VACUUM
Type of Gas/AirNacuum System (new and relocated)
Total#
Oxygen
Nitrous Oxide
Medical Air
Carbon Dioxide
Helium
Medical — Surgical Vacuum
Other:
I TOTAL OUTLETS
TANK#I
TANK #2
Method of Abandonment
Method of Abandonment
FillinPlacey
Fill Material foam
Fill in Place
F]
Fill Material
4 =wl:ii I
Removal
Number of Gallons: 300 gallons
Number of G''a"I'lons:
Critical Areas Determination: Study Required Conditional Waiver E] Waiver
INAWkILWAMEELVA
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 WaiverEl Waiver 0
PSCAA Case No.
AHERA Survey done? (required) E]
I
Additional comments:
'PnI?T%/T P T 1. -1-- 1 0. A - -:. .:-- I ...... %I-- � IAI I - - IT I. I . 1-- .
t
SEATTLE TANK SERVICE
PO BOX 31516
SEATTLE, WA 98103
206-938-2280
LICENSE# SEATTTT012Q4 EXP:11/19/2018
ICC LICENSE #8145449
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE ADDRESS: 10014 238"' St SW, Edmonds, WA 98020
OWNER: Thomas Sawyer
PHONE: 425-330-7440
ACTIVITY:
F� Pump, rinse and fill in place with foam, one 300 gallon underground residential heating oil tank. Cut
vent below grade.
10014 — house
LOO
Large asphalt parking area
th
238. Street SW