BLD0160988.pdfCity of Edmonds
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5't' Avenue N, Edmonds, WA 98020
Phone 425.771.0220 4 Fax 425.771.0221
PLEASE REFER TO THE PL UMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
10506 Robin Hood Dr, Edmonds, WA 98020
00571300200100
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes[] NoW
APPLICANT:
A
FicoCompany Inc.
Phone: FF
206-547-8347 2 6=548-9352
Address (Street, City, State, Zip):
E -Mail Address:
PO Box 31228 Seattle, Washington 98103
info@filcoenviro.com
PROPERTY OWNER:
Phone:
Fax:
Clayton Blair Leckie
206-963-6186
Address (Street, City, State, Zip):
E -Mail Address:
10506 Robin Hood Dr Edmonds, WA 98020
cblairl@yahoo.com
LENDING AGENCY:
Phone:
Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:*
Phone: Fax:
Filco Company Inc.
206-547-8347 L06-548-9352
Address (Street, City, State, Zip):
E -Mail Address:
PO Box 31228, Seattle, Washington 98103
info@filcoenviro.com
WA •State License #/Exp. Dat7:
*Contractor must have a valid City of Edmonds business license prior to doing work F1L O 1080RU 10%10/2015
in the City. Contact the City Clerk's Qfice at 425.775.2525
City Busitt �s License #/Ex . pp te:
NI '3 1/1/2016
PLUMBING MECHANICAL TANK DEMOLITION
DETAIL THE SCOPE OF WORK: _ Pumrinse and fill in place with foam, one 500 gallon
residential heating oil tank. Cut vent and fill pipe below grade.
Ideclare atttderiretaata. of perjury lams that lite inforniation I haipe rovided on this farm/applicatlon Is true, correct and comirdete,
and that I ant the property owner or dutlr authorized agent of
the property otwier to subnttt a perntit application to Lite 00' of
Edmonds.
Print Name: 7 / r,
Owner ❑ Agent/Other (specify): Contractor
Signature:..
Date:
FORM C LABuilding New Folder 2010TONE & x-ferred to L -Building -New drive\Form C 2014.docx Updated: 1/17/2014
FORM C L1Building New Folder 2010\DONE & x-ferred to L-Building-New drive\Form C 2014.docx I Updated: 1/17/2014
FILCO COMPANY INC. LICENSE#FILCOCI080RU EXP:10/10/2017
PO BOX 31228 ICC LICENSE #-. 5050940
SEATTLE, WA 98103
SITE PLAN Vil
HEATING OIL TANK DECOMMISSIONINI-O!
OWNER: Clavton Blair Leckie
. . ... ....... . . . . ............
ACTIVITY: pump, rinse and fill in place with foam, one 500 residential heating oil tank. Cut vent and fill pipe
below grade.