FIR2020-0081_City_Application_9.21.2020_2.46.44_PMof i:t�aBUILDING PERMIT
u APPLICATION
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: htto://www.edmondswa.aov/
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 9230 217th St SW Edmonds, WA 98020
Parcel: 00612900200500
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Frank Ng
Mailing Address: 9230 217th St SW
City/State/Zip: Edmonds, WA 98020
Phone #: 425-772-1283
Email: fng1017@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
City/State/Zip: Seattle, WA 98103
Phone M 206-547-8347
E-mail: Tim(Ulroenviro cpm
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Filco Company Inc.
Mailing Address: PO BOX 31228
City/State/Zip: Seattle. WA 98103
Phone #: 206-547-8347
E-mail: info@filcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
FILCOCIO80RU 12/31/2020
CITY OF EDMONDS BUSINESS LICENSE #: N R-024111
Permit #;
DetailsTYPE OF PERMIT (PrDV!de ❑ Accessory Structure/ ❑ Addition
Detached Garage
❑ Demolition
IKMechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
R Tank
❑ Tenant Improvement
❑ Other
Remodel Permit fees are based on:
The value of the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, labor, overhead,
and the profit for the work indicated on this application.
Valuation:
PROPOSED NEW SQUARE FOOTAGE FOR 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
Pump out triple rinse and fill with foam
one 300 residential heating oil tank.
I certify 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 I
agent of the property owner to submit a permit application to the City of
Edmonds.
Print Name: M lind HeS
Signature: �j Date 9/21/2n
GENERAL COMMERCIAL 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
MECHANICAL EQUIPMENT COUNTS (New and 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 FIXTURE COUNTS (New, Relocated or .. .
Qty Qty
Clothes Washer Tub/Showers
Dishwasher Backfiow Device (RPBA, DCDA, AVBJ
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:
Toilets Other:
BTUs Qty BTUs City
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert Other:
Furnace I I I Other:
Carbon Dioxide Nitrous Oxide
Helfum Oxygen
Medical Air Other:
Medical - Surgical Vacuum Other:
I Type of structure to be demolished:
Square footage of structure to be demolished:
AHERA Survey done? Y / N PSCAA Case #:
Critical Areas Determination: 1
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place IS/ FIII Material: Foam
Removal ❑ I Size of Tank (Gallons) 300
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Grading: Cut cubic yards
Fill cubic yards
Cut / Fill in Critical Area: Yes ❑ No ❑
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.