20180605143212.pdfE
City ofEdmonds
DEVELOPMENT SERVICES
PLUMBINGO MECIIANICAL, TANK' & DEMOLITION
PERMIT APPLICATION
121 5û'Avenue N, Edmonds, WA 98020
Phone 425.7 7 1.0220 ft p ax qZS.l I 1.0221
Parcel #:
004 19300000300
PROJECT ADDRESS (StreeÇ Suite #, City State, Zip):
2IgL2 86th PL W, Edmonds, WA 98026
".E*"ØIS THIS WORK ASSOCIATED WITH.A,NOTHER PROJECT? Y
Associated Permit #:
Phone:
206-547-8347 lïé'-snt-nrs,APPLICANT:
Filco Company Inc.
Add¡ess (Street, Cþ, State, Zip):
P0 Box 31228 Seattle, Washineton 98103
E-Mail Add¡ess:
info@filcoenviro.com
Phone:
425-770-0413
Fax:PROPERTY OWNER:
Elise Insram
E-Mail Address:
kerry@leapfrogre.com
Address (Street, City, State, Zip):
21912 86th PL W, Edmonds, wA 98026
Phone:Fax:LENDING AGENCY:
E-Mail Address:Address (Street, City, State, Zip):.
Phone:
206-547-8347 548-9s52
Fax:CONTRÄCTOR:*
Filco Comoanv Inc.
E-Mail Addiess:
info@filcoenviro.com
Address (Street, Cþ, State, Zip):
PO Box 31228. Seattle, Washineton 98103
*Contractor must have a valid City of Edmonds business license prior to doing work
in the City. Contact the City Clerk's Office at 425.775.2525
DETATL THE SCOPE OF WORK: Pump, rinse and llll in place with
TÄNKPLI]MBING MECIIANICAL DEMOLITION
foam, one 300 gallon
residential heating oil tank. Cut vent and fill pipe below grade.
V/A State License #/Exn. Date:
FILCOCIOSORU, IO/IO/2OT7
Citv Business License #lExn. Date:NR:.02411"1 12/31/2019
I decløre under penølty of perjury laws that the informølion I have provided on thk form/qplícøtÍon ß lrue, coruect and complele,
and thal I øm the property owner or duly authorízed agent of lhe property owner to submít a permìt application to the Cìty of
Edmonds.
owner E Aeenlother |7l (speciff)
Date: /, /5 / I fSignature:-4' Zqt^-ç17
ContractorPrintName: -fip 4 VøeS
PERMII' APPI-ICìA1-I(]N IIOR
PLEASE REFERTO THE PLUMBING & MECHANICAL CHECKLIST FORSUBMITTAL REQUIREMENTS
FORM C L,\Buildinn New Folder 20l0\DONE & x-fenert to L-Buiklins-New driveìFom C ?0l4 dncx I In¡laraã. 1 11 1 l'ro.t
^
Total#Type of Gas/Air/Vacuum System (new and relocated)
Oxygen
Nitrous Oxide
Medical Air
Carbon Dioxide
Helium
Medical - Surgical Vacuum
Other:
TOTALOUTLETS
MEDICAL GAS, AIR, VACUUM
I
TANK#2TANK#1
Method of AbandonmentMethod of Abandonment
Fill in Place Fill Material 'Fill in Place ,/Fill Material foam
RemovalRemoval
Number of Gallons:Number of Gallons:300 sallon
Critical Areas Determination: Study Required fl Conditional Waiver f] Waiver
TANK
Type of structure to be demolished (e.g. house, shedo garage, etc.):
Floor area of structure to be demolished: sq. fL
Areas Determination: Siudy Requhed fl Conditional Waiver WaiverCritical
AHERA Survey done? (requireÐ nPSCAA Case No.
Additional comments:
DEMOLTTION
F'ÔR M C T '\R¡ritd¡.a trter¡, Fnt¡ter 1ôl n\nôNrË R, t-€ç¡e¿l rn I -Þ,¡il¡lino-\larv ârir¡p\Fnm ? 1îl a Åarv ll¡¡la+a¡|. l lllllÀt n