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FIR2020-0079_Application_9.2.2020_3.50.30_PMCITY OF EDMONDS M BuildingPermit.com Fire Application #852131 - Schilke 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 7728 201 ST ST SW City Zip Code County Parcel Number EDMONDS 98026 27041900106800 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 RACHEL\ RICHARD A SCHILKE Number Street Apartment or Suite Number 7728 201 st ST SW City State Zip Edmonds WA 98026-6838 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: 9/2/2020 Submitted By: Heather Hendricks Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #852131 - Schilke 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: Schilke 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