Site plan for Tank.pdfC 0 C 10490 p o/�o%,7
L --C O® C. LICENSE# KP, 04
PO BOX 3'd ICC LICENSE #8145449„ ..............._
SEATTLE, WA 98103
206-, µ 0
SITE PLA
HEATING OIL TANK DECOMMISSIONING
JOB SITE ADDRESS: 8023 208TH PLACE SW, EDMONDS, WA 98026
OWNER: JONATHAN APO
PHONE: 206-280-5549
ACTIVITY:
El Pump, rinse and fill in place with foam, one 300 gallon underground residential heating oil tank. Cut
vent below grade.
208TH PLACE SW
PLEASE RE, R ER TO 774EF M, UMBING & MECRA NIC4 L CHECKLIST FOR SUBbfl 7TAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
DEVELOPMENT SERVICES
8023 208th PL SW, Edmonds, WA 98026
00558800001500
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes7 No7
PLUMBING, MECHANICAL, TANK, & DEMOLITION
APPLICANT:
phone: �47
PERMIT APPLICATION
le
Address (Stre"t flit State, Zip):
E -Mail Addresr s: 40t," n L 7112 V;
"q
121 50' Avenue N, Edmonds, WA 98020
'City
PROPERTY OWNER-
Phone 425.771.0220 2 Fax 425.771.0221
of Edmonds
206-280-5549
Address (Street, City, State, Zip):
PLEASE RE, R ER TO 774EF M, UMBING & MECRA NIC4 L CHECKLIST FOR SUBbfl 7TAL REQUIREMENTS
PROJECT ADDRESS (Street, Suite #, City State, Zip):
Parcel #:
8023 208th PL SW, Edmonds, WA 98026
00558800001500
Associated Permit #:
IS THIS WORK ASSOCIATED WITH ANOTHER PROJECT? Yes7 No7
APPLICANT:
phone: �47
F I L CO of Pjr,gip -0
le
Address (Stre"t flit State, Zip):
E -Mail Addresr s: 40t," n L 7112 V;
"q
PO l3w, ;)AReattle, Was]"ifilton 98103
info@S'e"'a Ir n
PROPERTY OWNER-
Phone:
Jonathan A
206-280-5549
Address (Street, City, State, Zip):
E -Mail Adclress:
8023 208th Pl, SW, Edmonds, WA 98026
kawikaa2o@hotmail.com
LENDING AGENCY:
Phone: Fax:
Address (Street, City, State, Zip):,
E -Mail Address:
CONTRACTOR:*
Phone:
F -f I— C 0 C6 1;qc
[Fax:
206-938-2280 06-933-1967
Address (Street City, State, Zip):
E -Mail, Addiess:
TO Box 3 Seattle, WashinglIon 98103
info@sftm4k4,P*kGoj,'n
WA State 1 �icense#/Exp. Det 1,1 'Nw
*Contractor must hme a valid City qfEdmonds brainess licenseprior to doing work z-*
inthe Cit, , Contact the City Clerk's Office at 425.775.2525
fihitsusiney Z 17
-0205 Pp ��e
,
PPLU'MIJING 11 MECHANICAL I TAN, DEMOLITION Lj
DETAIL THE SCOPE OF WORK. Pum LjL, 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 fornVapplication is true, correct and complete,
and that ant the property owner or duly authorized agentof
the proper t)p onwer to submit aperinit application to the Cl(y o
Edmonds.
Print Name:
Owner El Agent/Otber W] (specify): Contractor
Signature:
Date:
FORM C I Allnildi.. M- PMd')A1 O\T')OKIP k, —for A m 7 _R..: A,;—M— IM A A^-- I — -1 .
TANK #1 TANK #2
Method of Abandonment Method of Abandonment
Fill in Place Fill Material f"aaa Fill in Place Fill Material
Removal Removal
Number of Gallons: 300 gallons Number of Gallons:
Critical Areas Determination: Study Required o dilional " "aiv r Waiver
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