FIR2021-0152_Applicant_Response_12.23.2021_10.36.04_AM_2590213of I:f�,t,r� BUILDING PERMIT
,r 'o APPLICATION
v c n
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 tw hItta://www.edmondswa aov/
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 20829 74th Ave W Edmonds,WA 98026
Parcel: 00380100000105
Lot /Unit/Suite#: Subdivision:
PROPERTY OWNER:
Name: Shane Clays
Mailing Address: 20829 74th Ave W
City/State/Zip: Edmonds, WA 98026
Phone #: 206-660-4026
Email: Shane—clays@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: Tim4filinnPnviro oom
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Fllco Company, Inc.
Mailing Address: _ PQaQx 3.1228
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
ri
t #:
DetailsTYPF OF PERMIT (Provide
❑ Accessory Structure/ ❑ Addition
Detached Garage
❑ Demolition
IKMechanical
❑ 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 appllcation.
Valuation:
PROPOSED NEW.SQUARE FOOTAGE FOR THIS APPLICATION
Basement sq it: 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: Yelinda H ss
Signature:— Date 12/23/2021I
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.
TI / CHANGE OF USE / NEW BLDG: Include TRAFFIC IMPACT worksheet
EQUIPMENTMECHANICAL • . 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 Commercal 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 Bibs
Water Heater - Tankless? Y or N
Hydronic Heat
Water Service Line
Sinks
Other:
Toilets
Other:
CONNECTION COUNTSRelocated or
BTUs Qty BTUs City
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace Other:
COUNTSMEDICAL GAS, AIR VACUUM
(New, Relocated or .•.
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 ❑ Waiver ❑
Fill in Place q7 Fill Material: Foam
Removal ❑ 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.