FIR2021-0086_Applicant_Response_8.3.2021_1.03.03_PM_2336548BUILDING PERMIT
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.edmonclswa,t ov
JOB SITE INFORMATION/LOCATION: (Where the work is taking place)
Job Site Address: 9215 217th St SW Edmonds,WA 98020
11. •11 11 11
Lot /Unit/Suite #: Subdivision:
PROPERTY OWNER:
Name: Tim Rinaker
Mailing Address: 9215 217th St SW
City/State/Zip: Edmonds, WA 98020
Phone#: 415-690-6076
Email: t.rinaker@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 -547-8347
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: FIICo Company, Inc.
Mailing Address:__ PQ 13o 31228
City/State/Zip: Seattle, WA 98103
Phone #: 206-547-8347
E-mail: info a@filcoenviro.com
WA STATE CONTRACTOR L & I # (CCB) & EXPIRATION DATE:
FILCOCIO80RU 12/31/2021
CITY OF EDMONDS BUSINESS LICENSE #: NR-024111
Permits:
Of' PERMIT (Provide, ❑ Accessory Structure/
Detached Garage
DetailsTYPE
❑ Addition
((Mechanical
❑ Demolition
❑ New Single Family / Duplex
❑ Plumbing
❑ Fire Sprinkler
❑ 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 tripe rinse and fill with foam
one 300 gallon residential heating oil tank.
I certify that the information I have provided on this form/appllcation 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: Meliqjdq Hepp
Signature: L Date 8/3/2021
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.
FTl / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMMECHANICAL EQUIPMENT COUNTS (New and PACT worksheet
Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor
Air Handler /VAV
Boller
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 Backflow 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 Qty
A/C Unit Outdoor BBQ / Fire pit
Boiler Stove/Range/Oven
Dryer Water Heater
Fireplace/ Insert I I I Other:
I Furnace 1 1 1 Other:
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 I PSCAA Case #:
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver ❑
Fill in Place 4/ Fill Material: _ Fnam
Removal ❑ 1 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 Cl
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.