FIR2021-0033_Applicant_Response_4.12.2021_2.19.38_PM_2140771BUILDING PERMIT
APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
.nC. 1 Rqv 425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: www.edmondswa.gov.
PLEASE NOTE: Intake appointments are required for New Single Family
Residences, Large Additions, ADU's, New Commercial, and Major Tenant
Improvement application submittals. If plans are prepared by a profession-
al, electronic files are requested in addition to the hard copies. Please bring
electronic files on a flash drive or coordinate for electronic transfer.
Please call 425-771-0220 to schedule an intake appointment!
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job site Address: 6628 170th PL SW EDMONDS 9802
Parcel: 0041 A9Q0 0(l( q00
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Margaret Mcgowan
Mailing Address: 6628 170th PL SW
City/State/Zip: Edmonds WA 98026
Phone#: 495 77-3 1494
Email: joemagoo@gmail.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes 9 No
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: Tanks By Dallas
Mailing Address: 17552 Ballinger Way NE
City/State/Zip: Shoreline WA 98155
Phone #: 495-773-1494
E-mail: tanksbydallas@tanksbydallas.net
GENERAL CONTRACTOR: (If different from applicant)
General Contractor:
Mailing Address:
City/State/Zip:
Phone #:
E-mail:
STATE UBI #: 601972418-001-0001
CITY OF EDMONDS BUSINESS LICENSE #: N-026479
WA STATE CONTRACTOR L & 1 #: (CCB) & EXPIRATION DATE:
tanksd*001 KF 2022
=Permt#
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 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 existing contents triple rinse fill in
place (1) 300-gallon UST with sand/slurry mix.
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
agent of the property owner to submit a permit application to the City of
Edmonds. v 11
Print Name: • O 1l boi
- _-- \�ann r,,.a 4111a1A
E N ERAL COM M ERCIAL: DATA
Occupancy Grodp(s)' occupant Load(s):
Type(s)-of Construction:
Fite SOrinklers: yes- 0 No..[]*
'WA STATE ENERGY CODE:.If your prdje;t0ffects:the building.envelop.p,
mechanical sy* sterns,and/or.lighting,you must complete the -
appropriate WSEC forms:
DEFERREDSUBMITtALS: All commercial. bul Idin.gp4r'mitt.�that-willre*quire
associated plumbing, mechanical; fire sprinkler,. a ndlot fire alarm
*permits are applied fo.r.separately.
TI / CHANGE OF USE */*NEW BLDG: Include TRAFFIC IMPACT worksheet
MECHANICAL EQUIPMENT COUNTS (New and Relocated)
BTUs Gas] Elec./ Other Qty
A m1it/C0 mpressor
. .
Air Handler NAV
Boiler
Dryer Duct
Exhaust. Fans
Fireplace
.Furnace
Heat . Pump Unit
Hydrorfic Heating
Roof Top* Unit (Provide eleva-
. dons if Commercial Bldg)
.Other-.
.. ........ . . ... . ........ ...... .
PLUMBING FIXTURE COUNTS (New, Rel6c - ated or -re-piped.)
.Qty Qty
Clothes Washer
Tub/ Showers.
bishwasher
8ackfId w* Device*(06A, DCDA, AVS).
Drinking Fountain
Pressure Reduction/.. Regulator Valye -
Flooe*Dra*ihjSink
Refri er g ator Water Supply*
Hose Bibs
Water Heater -Tanklets? Yor-N
...Hydronic Heat.
Water Service Line.
Sinks:
Other:.
Toilets
Other:*
GAS/FUEL CONNECTION COUNTS (New, Relocated or re -piped)
BTUs. 'Qty BTUs. Qty
.A/C- Unit
Outdoor-BBQ Fire pit
Boiler
StoVe/Ranige/Oven
Dryer.
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICA ' L GAS,. AIR `VAtU'U M CO U14TS
(New'.Relocatedor.r.e-pipedl
Qty Oty
Carbon Dioxide.
*Ni Nitrous Oxide
Helium
Oxygen
Medical Air
Other:.
Medical - Surgical Vacuum ..Other:
Type.cf struc . ture.to be -demolished:
Square footage of structure to. be demolished:
AHERA Survey done? N.
PSCAA Case
Critical Areas Determination:
Study Required [3 Condi.tionaiWa.iver-11. Waiver[]
Fill: in *Place Fill m4terial: sand/slurcy
Removal 0
Sizedf-Tank .(Ga lions) :no
Critical Areas Determination;
Study Required EY Conditional Waiver U Waiver 0
GRADE/FILL/EXCAVATE
Grading: Cut cubic yards
Fill cub1c.yards-
Cut/ Fill inCHticalArea:- Yes[] No.0-
GENERAL PROVISIONS
APPLICATIONS: .Applications ..are.va.li..d for a.. maximum of-1year.
ESI-H.A.Applications, 2 years:
.LICENSING`: All contractors and subcontractors. are requir0d.tq be licensed
with Washington State D.epartmentof Labor8i Industriesandhave.a
current City *611' Edmonds Rusiness1icense.