BLD20160619.pdf1.
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 2 Fax 425.771.0221
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PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR
SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
727 4th Ave S, Edmonds, WA 98020
27032600101800
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes[] Nolz
Associated Permit #:
APPLICANT:
Phone: FF
Filco Company Inc.
206-547-8347 26-548-9352
Address (Street, City, State, Zip):
E -Mail Address:
PO Box 31228 Seattle, Washington 98103
info@filcoenviro.com
PROPERTY OWNER:
Phone: Fax:
Keerat & Stephanie Sharma
206-643-6642
Address (Street, City, State, Zip):
E -Mail Address:
727 4th Ave S Edmonds WA 98020
keeratandste h@ mail.com
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):
E -Mail Address:
CONTRACTOR:*
Phone: Fax:
Filco Com an 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. Date:
*Contractor must have a valid City of Edmonds business license
prior to doing work FILCOC108OI 10/10/2015
in the City. Contact the City Clerk's Office at 425.775.2525
City Business License #/Ex. ate:
NR -02053 131/2016
PLUMBING MECHANICAL TANK ,�/! ]DEMOLITION
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 ititder perrrrl r of perjury laws Brat fit it iforinatioit I have provided on this fornar'application Is tree e, correct a)'Ad 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
Edmonds.
Print Name: 777 �7 A " ..
Owner ❑ Agent/Other Z (specify): Contractor
Signature: r3•,
5/ 1 Id -O �
Date: 6
FORM C'. i \Rn;lA;no TTvoi Pn41— 100 MT)CYM : R. -f.-1 to T t, )M A .1^-- 7 T_ _ , n ., r,n, .
TANK #177
TANK #2
Method of Abandonment Method of Abandonment
Fill in Place[21 Fill Material foam Fill in Place Fill Material
-
Removal Removal
Number of Gallons: 300 gallon Number of Gallons:
Critical Areas Determination: Study Required Conditional Waiver [:]Waiver
FILCOCOMPANY INC. LICEN3E#FlLCOCl080RUE%P:10/10/2017
PDBOX 31328 ICC LICENSE
SE/TTLE,VVA98103
SITE PLAN
AEATING OIL TANK DECOMMISSION INI?
JOB SITE ADRES5AVE S EDMONDS --W&-98020
OWNER:
PHONE
Pump, rinse & fill in place foam, one 300 gallon residential heating oil tank. Cut fill pipe and vent
pipe below grade and cap.
4TH AVE SOUTH