FIR2021-0128_Applicant_Response_11.16.2021_2.55.39_PM_2523566BUILDING 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: htt}> /�wwdmonds��,+.t;uy[
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 23816 101 st Ave W Edmonds,WA 98020
11. :11111 11
Lot /Unit/Suite M Subdivision:
PROPERTY OWNER:
Name: Steve Zamberlin
Mailing Address: 23816 101 st Ave W
City/State/Zip: Edmonds, WA 98020
Phone #: 206-380-2854
Email: atlaw1234@yahoo.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: Tim4filc:nPnviro com
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: F11co 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 q (CCB) & EXPIRATION DATE:
FILCOCIO80RU 12/31/2021
CITY OF EDMONDS BUSINESS LICENSE M N R-0241 11
Permit #: 7
❑ Accessory Structure/
Detached Garage
.-
❑ Addition
❑ Demolition
❑ New Single Family / Duplex
()(Mechanical
❑ Plumbing
i
❑ Remodel I
❑ Re -Roof
jai Tank
❑ Fire Sprinkler
❑ New Commercial/ Mixed Use
❑ Signs
❑ Tenant Improvement
i
❑ 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 SQUARL FOOTAGE POR 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 excavate and remove
one 300 gallon residential heating oil tank.
. haul old tank away and properly
dispose of 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
Edmonds. � � , - �- • - �,• - -•-• -- -• •- - • -•
Print Name: Melinda Hess •
r
Signature: �S Date 11 /1 /2021
Occupancy Group(s)
Type(s) of Construction:
Occupant Load(s):
Fire Sprinklers: Yes ❑ No ❑
WA STATE ENERGY CODE: If your project affects the building envelope,
mechanical systems, and/or Ilghting, 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.
FT1 / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL •
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:
FIXTURE
Qty
COUNTSPLUMBING or re -piped) M
Qty
Clothes Washer
Tub/Showers
Dishwasher
Backfiow Device (RPBA, DCDA, AVB)
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:
COUNTSGAS/FUEL CONNECTION
BTUs Qty BTUs City
A/C Unit
Outdoor BBQ/ Fire pit
Boller
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
MEDICAL GAS, AIR VACUUM COUNTS
(New, Relocated or re -piped)
Qty
Qty
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 ❑ Waive
Fill in Place ❑ FIII Material:
Removal I Size of Tank (Gallons) 300
Critical Areas Determination:
Study Required ❑ Conditional Waiver ❑ Waiver
•,DEXCAVATE
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.