Loading...
FIR2021-0045_Applicant_Response_4.30.2021_11.15.55_AM_2173156oBUILDING PERMIT �o APPLICATION Development Services Building Division 121 5th Ave N / Edmonds, WA 98020 C. 18 425.771.0220 For handouts, submittal requirements, permit status and inspection scheduling information go to: li"t):/Iwww.cdmonoAwa.gov/­ JOB SITE INFORMATION/LOCATION: (Where the work is taking place) Job Site Address: 19213 Olympic View Dr Edmonds,WA 98 Parcel: 00434600008304 Lot /Unit/Suite #: Subdivision: PROPERTY OWNER: Name: Anthony Sajec Mailing Address: 19213 Olympic View Dr City/State/Zip: Edmonds, WA 98020 Phone #: 206-229-2715 Email: tony.sajec@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 AXres Mailing Address: PO BOX 31228 City/State/Zip: Seattle, WA 98103 Phone #: 206-547-8347 E-mail: __TIM filrnenviro Com GENERAL CONTRACTOR: (If different from applicant) General Contractor: FiICO COMP -any, 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 & 1 # (CCB) & EXPIRATION DATE: FILCOCIO80RU 12/31/2021 CITY OF EDMONDS BUSINESS LICENSE #: N R-024111 Permit 1f: TYPE OF: PERMIT (Provide ❑ Accessory Structure/ Detached Garage Detuils on Page 2) ❑ Addition ❑ Demolition CKMechanical ❑ New Single Family / Duplex )20— ❑ Fire Sprinkler ❑ Plumbing ❑ Remodel ❑ New Commercial/ Mixed Use ❑ Re -Roof X Tank ❑ Signs ❑ 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 DESCRIPTION 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 agent of the property owner to submit a permit application to the City of Edmonds. Print Name: Mel da SS I r Signature: -� u Date 4/30/2021 Occupancy Group(s): I Occupant Load(s): Type(s) of Construction: I Fire Sprinklers: Yes ❑ No ❑ WA STATE ENERGY CODE: If your project affects the building envelope, mechanical systems, and/or Iightln& 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. FTI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet EQUIPMENTMECHANICAL • BTUs Gas / Elec / Other City 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: FIXTURE Qty COUNTSPLUMBING Relocated or .. . City 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 Water Service Line Hydronic Heat Sinks Other: Toilets Other: CONNECTION COUNTS BTUs City BTUs City A/C Unit Outdoor BBQ/ Fire pit Boiler Stove/Range/Oven Dryer Water Heater Fireplace/ Insert Other: Furnace Other: MEDICAL• ..r re-pipe 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 ❑ "inPlace FillMaterial: loam Removal ❑ i Size of Tank (Gallons) 300 Critical Areas Determination: Study Required ❑ Conditional Waiver ❑ Waiver ❑ A•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.