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FIR2020-0049_Application_5.22.2020_12.23.42_PMCITY OF EDMONDS M BuildingPermit.com Fire Application #808373 - Lemieux tank decommissioning Applicant First Name Last Name Company Name Heather Hendricks Tanks by Dallas Number Street Apartment or Suite Number E-mail Address 17552 Ballinger Way NE tanksbydallas@tanksbydallas.net City State Zip Phone Number Extension Lake Forest Park WA 98155 (206) 365-0291 Contractor Company Name Tanks by Dallas Number Street Apartment or Suite Number 17552 Ballinger Way NE City State Zip Phone Number Extension Lake Forest Park WA 98155 (206) 365-0291 State License Number License Expiration Date UBI # E-mail Address tanksd*001 kf 5/6/2021 FD1 q7941 R tanksbydallas@tanksbydallas.net Project Location Number Street Floor Number Suite or Room Number 415 3RD AVE N City Zip Code County Parcel Number EDMONDS 98020 00592200001600 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Adam S & Summer N Lemieux Number Street Apartment or Suite Number 415 3RD AVE N City State Zip EDMONDS WA 98020-3111 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 5/22/2020 Submitted By: Heather Hendricks Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #808373 - Lemieux tank decommissioning Project Contact Company Name: Tanks by Dallas Name: Heather Hendricks Email: tanksbydallas@tanksbydallas.net Address: 17552 Ballinger Way NE Phone #: (206) 365-0291 Lake Forest Park WA 98155 Project Type Activity Type Scope of Work Single Family Residential Decommission Other Project Name: Lemieux tank decommissioning Description of Work: Pump out existing contents, triple rinse, fill in place (1) 300-gallon UST with sand/slurry mixture. Project Details Storage Tank Work Tank Decommission Page 2 of 2