FIR2020-0113_Site_Plan_12.16.2020_10.13.15_AM_1950168FILCO COMPANY INC.
PO BOX 31228
SEATTLE, WA 98103
LICENSE#FILCOCIO80RU EXP: 12/31/2020
ICC LICENSE # 8291441
SITE PLAN
HEATING OIL TANK DECOMMISSIONING
JOB SITE ADRESS: 22422 9611 Ave W Edmonds, WA 98020
OWNER: Marie Meyer
PHONE: 206-200-4816
ACTIVITY: Pump out, triple rinse and fill in place with Foam one 300 gallon underground residential
heating oil tank.
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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 Commerclal Bldg(
Other:
PLUMBING• .. ..
Qty 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:
Toilets
Other:
CONNECTION COUNTSor re -piped)
BTUs Qty BTUs Qty
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
.. .•.
Qty Qty
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
I PSCAA Case k:
Critical Areas Determination:
Study Required El Conditional Waiver ❑ Waiver ❑
Fill in Place Nf Fill Material: Foam
i
Removal ❑ 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 ❑
GENERAL PROVISIONS
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.
oj0 BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
112 t R(P 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: htt )://wvjw.edmondswa.gov
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 22422 96th Ave W Edmonds, WA 98020
Parcel: 00559000200800
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Marie Meyer
Mailing Address: 22422 96th Ave W
City/State/zip: Edmonds, WA 98020
Phone #: 206-200-4816
Email: mmclt515@live.com
OWNER INSTALLATION: "If yes, read and sign"
Will work be performed by the property owner? ❑ Yes 1XNo
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 #: _206-547-8347
E-mail: Tim 4fiIcnenviro .om
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: FIIco 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-0241 1 1
i )Ihc v U%c Only
TYPE OF
❑ Accessory Structure/
❑ Addition
Detached Garage
❑ Demolition
()(Mechanical
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ Signs
Tank
❑ Tenant Improvement
❑ Other
Remodel Permit fees are based on:
The value or the work performed. Indicate the value (rounded to
the nearest dollar) of all equipment, materials, lanor, 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/appllcadon 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: MellndaJ-less
Signature: G �� ate 12/16/202