FIR2022-0014_Applicant_Response_2.10.2022_12.22.31_PM_2673888BUILDING 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: litto;//www.edmondswa.gQ[
JOB SITE INFORMATION/LOCATION: (Where the work Is taking place)
Job Site Address: 22710 96th Ave W Edmonds,WA 98020
Parcel: 0040S0700A00005
Lot /Unit/Suite M Subdivision:
PROPERTY OWNER:
Name: Blake Fisher
Mailing Address: 22710 96th Ave W
City/State/Zip: Edmonds, WA 98020
Phoned: 206-852-5054
Email: blakefisher3@gmail.com.com
OWNER INSTALLATION: *If yes, read and sign*
Will work be performed by the property owner? ❑ Yes 1XNo
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
IV aa(1 •—a • Wu
GENERAL CONTRACTOR: (If different from applicant)
General Contractor: Filco Cor-opany. Inc.
Mailing Address: PO BOX 31228
City/State/Zip: Seattle, WA 98103
Phone tf: 206-547-8347
E-mail: info@filcoenviro.com
WA STATE CONTRACTOR L & I ft (CCB) & EXPIRATION DATE:
FILCOCIO80RU 12/31/2022
CITY OF EDMONDS BUSINESS LICENSE fl: N R-024111
Permit #:
TYPE OfPERMIT (I'Tovide
.-
❑ Accessory Structure/
Detached Garage
❑ Addition
❑ Demolition
IKMechanical
❑ Plumbing
❑ New Single Family / Duplex
❑ Fire Sprinkler
❑ Remodel
❑ New Commercial/ Mixed Use
❑ Re -Roof
❑ 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 SQUAREas a• 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 500 gallon 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 appllcation to the City of
Edmonds.
Print Name, Melinda Hess
Signature: C�-� Date . 2/10/2022
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
EQUIPMENTMECHANICAL • Relocated)
BTUs Gas / Elec / Other Qty
A/C Unit /Compressor �I
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:
COUNTSPLUMBING FIXTURE .. .. .
Qty City
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
Water Service Line
Hydronic Heat
Sinks
Other:
Toilets
Other
COUNTSGAS/FUEL CONNECTION
BTUs City BTUs City
A/C Unit
Outdoor BBQ/ Fire pit
Boiler
Stove/Range/Oven
Dryer
Water Heater
Fireplace/ Insert
Other:
Furnace
Other:
MEDICAL•
(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 FP SCAA Case #:
Critical Areas Determination:
i
Study Required ❑ Conditional Waiver ❑ Waiver ❑
FIII in Place q! Fill Material: Fnnm
Removal ❑ Size of Tank (Gallons) 500
— — - i
Critical Areas Determination:
I
Study Required ❑ Conditional Waiver ❑ Waiver ❑
.•
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.