FIR2020-0074_City_Application_8.4.2020_4.10.45_PMBUILDING PERMIT
'o APPLICATION
c/
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: httn:/Jwww.edfnondswa.gov/
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 23700 Edmonds Way Edmonds, WA 9802
Parcel: 00463300300402
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Richard & Anne Kitaeff
Mailing Address: 23700 Edmonds Way
City/State/Zip: Edmonds, WA 98026
Phone #: 425-750-5230
Email: rjkitaeff@gmail.com
OWNER INSTALLATION: 'If yes, read and sign"
WIII work be performed by the property owner? ❑ Yes IXNo
I own, reside In, or will reside in the completed structure.
This installation is being made on property that I own which is
not intended for sale, lease, rent, or exchange according to
RCW 18.27.090.
Owner Signature:
APPLICANT / CONTACT INFORMATION:
Name of Applicant: Tim Ayres
Mailing Address: PO Box 31228
C•rcy/state/zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail:
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Fllco Company, Inc.
Mailing Address: PO Box 31228
City/State/Zip: Seattle, WA 98103
Phone #: 206-547-8347
Email: info@filcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
FILCOCIO80RU 12/31/2020
CITY OF EDMONDS BUSINESS LICENSE #: N R-024111
Permit;
Of: PERMIT (Provide
❑ Accessory Structure/
Detached Garage
DetailsTYPF
❑ Addition
[$Mechanical
❑ Demolition
❑ New Single Family / Duplex
❑ Plumbing
El
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑Re -Roof
Vank
ElSigns
❑ Tenant Improvement ❑ Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value Irounded to
the nearest dollar) of all equipment, materials, labor, overhead, -
and the profit for the work indicated on ihls application.
Valuation:
PROPOSEDNEW.SQUAREFOOTAGE O, THIS APPLICATION
Basement sq ft: Finished ❑ Unfinished ❑
1st Floor, sq ft:
2nd Floor, sq ft:
Garage/Carport:, sq ft:
Deck/Covered Porch/Patio:
Other sq ft:
PROJECT DESCRIPTION
Pump out and remove one 300 gallon
residential heating oil tank. Loaded onto
Filco truck and transmitted to Filco. And tank
will be properly disposed of. Backfill excavatio
I certify that the information I have provided on this form/appllcation 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.
Print Name: Melinda Hess
Signature: fJ� Date 8/4/2020
GENERAL. DATA
Occupancy Group(s): Occupant Load(s):
Type(s) of Construction: Fire Sprinklers: Yes ❑ No ❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or lighting, you must complete the
appropriate WSEC forms.
DEFERRED SUBMITTALS: All commercial building permits that will require
associated plumbing, mechanical, fire sprinkler, and/or fire alarm
permits are applied for separately.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL • Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boiler
Dryer Duct
Exhaust Fans
Fireplace
Furnace
Heat Pump Unit
Hydronic Heating
Roof Top Unit (Provide eleva-
tions If a Commercial Bldg)
Other:
PLUMBING•Relocated.
City Qty
Clothes Washer
Tub/ Showers
Dishwasher
BackFlow Device (RPBA, DCDA, AVB)
Drinking Fountain
Pressure Reduction/ Regulator Valve
Floor Drain/Sink
Refrigerator Water Supply
Hose Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
To
Other:
CONNECTIONCOUNTS
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL•
.. .•
Qty
City
Carbon Dioxide
Nitrous Oxide
Helium
Oxygen
Medical Air
Other:
Medical - Surgical Vacuum Other:
DEMOLITION
Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N
PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver El
wliFill
in Place ❑ Fill Material:
,! Removal �!J � Size of Tank (Gallons) 300
I
Critical Areas Determination:
Study Required 5 Conditional Waiver ❑ Waiver ❑
•A,LL/EXCAVATE
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
GENERAL•• •
APPLICATIONS: Applications are valid for a maximum of 1 year.
ESLHA Applications, 2 years.
LICENSING: All contractors and subcontractors are required to be licensed
with Washington State Department of Labor & Industries and have a
current City of Edmonds Business License.