BLD20170280.pdfo � �
CIT Y uFt"DMONDS1215TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425)771-0221
STATUS: ISSUED 02/24/2017
Expiration Date: 08/24/2017
Parcel No: 00476000001000
APPLICANT CONTRA('I"OR
GLENN R STRAIT CASCADE WEST TANK SERVICES . CASCADE WEST TANK SERVICES
10703 231 ST ST SW C/O VICTORIA BLOOM C/O VICTORIA BLOOM
EDMONDS, WA 98020-6154 18527 28TH AVE NE 18527 28TH AVE NE
LAKE FOREST PARK, WA 98153' LAKE FOREST PARK, WA 98153
(206)946-6910 (206)946-6910
LICENSE #g CASCAWT862C8 EXP:08/15/201
Pump out contents,' triple rinse with degreaser. Fill'with sand 1300 gal oil tank.
VALUATION: $0.00
I,ACrii1;,F
TO COMPLY WITH CITY AND STATE' LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
141BY,NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
3 PP'I('r1TQNIS CTAPERMITUNTILSIGNEDBY,THE IJ1LDINGOFFICIALORHIS/HERDEPUTYANDALLFEESAREPAID,
Bip1It1re
Print Name Date Released y "Date
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBCI09/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR 15aDTfIER
0, t" E D `17 t�
Al
DEVELOPMENT SERVICES
PLUMBING, MECHANICAL, TANK, & DEMOLITION
PERMIT APPLICATION
121 5`h Avenue N, Edmonds, WA 98020
Phone 425.771.0220 ft Fax 425.771.0221
City of Edmonds
PLEASE REFER TO THE PLUMBING & MECHANICAL CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite llL,at.y State, Zip): Parcel #:
C o L,21.., V
`V I Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes ❑ No
APPLICANT: Phony,: Fax:
( y
,7i): E -Mail Address:
Address Street, it tate,
a
. t'P "'uCr" ' m �Gi Pti-s%
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PROPERTY OWNER: yp Phone: Fax:
Address(Street, City,8' State, Z:y� E -Mail Address:
LENDING AGENC : Phone: Fax:
Address (Street, City,t«tte'; "Zile): E -Mail Address:
CONTRACTOR:* Phone: Fax:
Address (Street, Cit, State Zip): E -Mail Address',
... Z
WA State LicenseILxp.r Date:
*Contractor must have a valid City of Edmonds business license prior to doing work (r',,' %qtr • ,
in the City. Contact the City Clerk's Office at 425.775.2525 City Business License #/Exp. Date:
PLUMBING MECHANICAL TANK w DEMOLITION
DETAIL THE SCOPE OF WORK: .... -- ..... ---- - . ... .... . -......
� a
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 property owner or duly authorized agent of the property owner to submit a permit application to the City of
Edmonds. ,0
Print Name: �_... ) �f'." '..... . _. Owner ❑ Agent/Other� specify):,
Signature: �..�.... Dater
FORM C L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.docx Updated: 1/17/2014
F®RMC L:\Building New Folder 2010\DONE & x-ferred to L Building -New drive\Form C 2014.docx Updated: 1/17/2014
Bid Sheet
Dates Name Lo �,
Address 10701
Phone#Email
Vacant Pets Owner? Agent
Tank LocationR r Fill pipe above grade
Total Depth Fill Pipe Diameter
Contents : Oil Water d, Other
:7
Field Notes
Office Notes
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