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FIR2021-0113_Application_10.8.2021_3.25.43_PM_2453423CITY OF EDMONDS M BuildingPermit.com Fire Application #1032247 - 715 Applicant First Name Last Name Company Name VICTORIA BLOOM CASCADE WEST TANK SERVICES Number Street Apartment or Suite Number E-mail Address 18527 28 ave ne cascadewest@outlook.com City State Zip Phone Number Extension Seattle WA 98155 2069466910 Contractor Company Name CASCADE WEST TANK SERVICES Number Street Apartment or Suite Number 18527 28TH AVE NE City State Zip Phone Number Extension LK FOREST PARK WA 98155 (206)6833599 State License Number License Expiration Date UBI # E-mail Address CASCAWT862C8 8/28/2022 FD:3iR4g46 cascadewest@outlook.com Project Location Number Street Floor Number Suite or Room Number 715 7TH AVE N City Zip Code County Parcel Number EDMONDS 98020 27032400207200 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Margaret Westbrook Number Street Apartment or Suite Number 2614 237TH PL SW City State Zip BRIER WA 98036 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 10/8/2021 Submitted By: VICTORIA BLOOM Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Fire Application #1032247 - 715 Project Contact Company Name: CASCADE WEST TANK SERVICES Name: VICTORIA BLOOM Email: cascadewest@outlook.com Address: 18527 28 ave ne Phone #: 2069466910 Seattle WA 98155 Project Type Activity Type Scope of Work Single Family Residential Decommission Other Project Name: 715 Description of Work: pump out contents of 1 500 gallon heating oil tank. triple rinse tank and fill with sand. Cut all piping below grade and cap with cement Project Details Storage Tank Work Date of Decommissioning 10/12/2021 Tank Decommission Page 2 of 2