BLD20160925.pdfDEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5"' Avenue N, Edmonds, WA 98020
City of EdmondsPhone 425.771.0220 2 Fax 425.771.0221
m
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #:
8616 196th St SW, Edmonds, WA 98026 00549200000200
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes[] NoV
APPLICANT: Phone: F
Filco Company Inc. 206-547-8347 2 -548-9352
Address (Street, City, State, Zip): E -Mail Address:
PO Box 31228 Seattle, Washington 98103 info@filcoenviro.com
PROPERTY OWNER: Phone: Fax:
William Mann 425-985-5564
Address (Street, City, State, Zip): E -Mail Address:
8616 196th St SW Edmonds WA 98026 bmann63@aol.com
LENDING AGENCY: Phone: Fax:
Address (Street, City, State, Zip): E -Mail Address:
CONTRACTOR:* Phone: Fax:
Filco COMDany Inc. 206-547-8347 L06-548-9352
Address (Street, City, State, Zip): E -Mail Address:
PO Box 31228 Seattle, Washington 98103 info@filcoenviro.com
Contractor must have a valid City of Edmonds business license prior I to doing work A State License 0R #/Exp. Date:
* � �ILCOC1080RU .10/10/2015
in the City. Contact the City Clerk's Ofj' ce at 425.775.2525 City Business License #/Ex. ate:
INR -02053;3 1�2?31 /2016
PLUMBING MECHANICAL TANK DEMOLITION Li
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 of perjury laws that the information I have provided on this form/application is true, correct and complete,
and that I am the propero� owner or duly authorized agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: / M 4qg C- Owner ❑ Agent/Other ❑] (specify): Contractor
Signature: Date:_7 WZ 16
FORM C i \RnilAino NT— PM4101 h\T%OVP R. —f matt f . i r IM n .7..n.. TT-J_._J- 1 11 -1 .
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 ❑ Conditional Waiver ❑ Waiver
PSCAA Case No. AHER Survey done? (required)
Additional comments:
'P I K I\/1 1 i .\D..: L1: wT ... T...I r Tl..C1 J:__ IT....
FILCO COMPANY INC. LICENSE#FILCOCI080RU EXP:10/10/2017
PO BOX 31228 ICC LICENSE #_ 5050940
SEATTLE, WA 98103
SITE PLAN I
VEATING OIL TANK N
JOB SITE ADRESS: 1 i 19 a' t C- g ,nd , WA9 02
OWNER: Bill Mann
PHONE:, 425-85-5564
ACTNM: pump, rinse and fill in place with foam, one 300 residential heating oil tank. Cut fill pipe below
grade.
196 1h Street SW