FIR2021-0058_Applicant_Response_6.18.2021_8.50.55_AM_2257605ox- F. 1)4/0 BUILDING PERMIT
tiv APPLICATION
Development Services
Building Division
121 5th Ave N / Edmonds, WA 98020
C. I �
425.771.0220
For handouts, submittal requirements, permit status and inspection
scheduling information go to: httjj.jLvww&Aungndsw;r,t'ov/
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 19303 80th PL W Edmonds,WA 98026
WOUVAOTITITITITF.,11
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Nadar Harb
Mailing Address: 19303 80th PL W
City/State/Zip: Edmonds, WA 98026
Phone #: 206-949-9030
Email: nnhwa@hotmail.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 #: -206-547-8347
E-mail: Timafilrn
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Fllco 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 12/31/2021
CITY OF EDMONDS BUSINESS LICENSE #: N R-024111
Permit:
Of: PERMIT (Provide ❑ Accessory Structure/
Detached Garage
DetailsTYPE
❑ Addition
XMechanical
❑ Demolition
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ Remodel
❑ Re -Roof
❑ New Commercial/ Mixed Use
❑ Signs
X 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 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: Melinda Hes,
Signature: Date 6/17/2021
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• 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:
COUNTSPLUMBING FIXTURE • .. • .
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 Blbs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
BTUs City BTUs Qty
A/C Unit Outdoor BBQ/ Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert I I I Other:
Furnace I I I Other:
Qty
Carbon Dioxide Nitrous Oxide
Helium Oxygen
Medical Air Other:
Medical - Surgical Vacuum Other:
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 ❑
FIII in Place 4/ FIII Material: Foam
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 ❑
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.